Articles indicating that the use of antibiotics has a negative effect on parts of the immune system by destroying the anaerobic flora in the intestinal tract thus allowing Clostridium difficile to grow. Suggestions abound for the cutback in the use of broad spectrum antibiotics, the use of antibiotics only when necessary, and only those specifically targeting the disease being treated thereby reducing the negative effect.
Details a study conducted with 6,129 patients over a 21 month period to investigate the effect of a narrow-spectrum antibiotic policy on antibiotic prescription and Clostridium difficile infection (CDI) rates through a departmental audit and feedback program to doctors. " It targeted broad-spectrum antibiotics for reduction (cephalosporins and amoxicillin/clavulanate) and narrow-spectrum antibiotics for increase (benzyl penicillin, amoxicillin and trimethoprim)." The main findings were that the audit and feedback program indicated a significant reduction in the use of broad spectrum antibiotics and a significant reduction in CDI.
Gives an overall description of C-difficile with symptoms, diagnosis, revention, treatment and prognosis. Indicates that the delicate balance between normal bacteria and pathogens is disrupted by antibiotic treatment which kills off large numbers of the normal bacteria in the bowels and allows the pathogens to multiply. Normally this can produce a mild case of diarrhea but at other times can result in high fevers, high-volume, watery diarrhea, severe abdominal pain, and a complication called toxic megacolon (enlarged colon) in about 3% of those having it. In severe cases which are treated successfully, between 15-35% have a relapse within 8 weeks after treatment ends.
Describes trials on novel therapies for reducing the interruption of anaerobic flora in intestinal tract, which leads to onset as well as relapse, while increasing activity against the pathogen or binding toxins produced by C difficile, plus a new test which shortens diagnosis time to two hours. Suggests therapies which will spare the anaerobic flora in the intestinal tract which is disrupted by the current use of antibiotics causing relapse and further complications particularly in new emerging strains of the pathogen. It is suggested that selective new treatments must neutralize the pathogen but allow the normal microbiota to rebalance itself. Two novel therapies being tested are described: One which binds the toxins produced by C difficile, and the second, the use of macrocyclic antibiotic PAR-101 (Optimer/Par) which has shown activity against C difficile 8- to 10-fold greater than that of vancomycin, with limited activity against most members of the normal intestinal flora. Also mentioned are newer tests using real-time polymerase chain reaction (PCR) to detect toxins A and/or B directly from stool which in tests are more sensitive and have been shown to shorten diagnosis time to two hours as against enŽzyme ŽimŽmunoassays (EIAs) currently used.