Many patients and physicians have been inquiring about Clostridium Difficile colitis (C.difficile). Infections are now more common even without a recent exposure to antibiotics.
Other risk factors include: age over 65, recent hospitalization, immune suppression, multiple comorbidities, history of inflammatory bowel disease, and proton pump inhibitor use. The presence of C. difficile is screened for common antigen GDH (glutamate dehydrogenase). This is useful if GDH is negative however C.dffiicile is present in 1.9% of these GDH negative cases. GDH is not specific to C.difficile and a confirmatory test with Enzyme Immunoassay (EIA) for toxin A and/or B (65-80% sensitivity) or PCR for toxin B is used. Testing only for toxin A will miss Toxin A negative Toxin B positive strains (1-3% of cases).CytotoxinB tissue assay was the “gold standard” but now PCR for Toxin B is available. Clinical judgement is ulitimately the deciding factor in treatment especially with negative studies.
Mild C. Difficile is treated with Flagyl 500mg TID po for 14 days. Moderate disease is treated with Vancomycin 125mg QID for 14 days. In severe hospital cases IV Flagyl and po Vanomycin are both utilized. Other treatments include Saccromyces Boulardii (VSL#3, Florastor), nitazoxanide, and xifaxan. Fecal transplant may be considered in refractory disease. Colectomy may be needed for severe life threatening disease.
