This discussion is going a little bit off the rails. Most c. diff. infections are cured with a single course of flagyl and do not result in hospitalization, year-long illnesses, or need for infectious disease or GI consultation. I’m a primary care doctor. In 20 years, I have never seen someone reqiuire hospitalization for c. diff except in a small handful of cases where the healthcare providers ignored patient complaints of severe diarrhea for days (a week, really). I have seen 1 or 2 cases with a single recurrence. I have no patients who required fecal transplant or vanco taper. I do discuss c. diff. when explaining to patients why I don’t want to give antibiotics unnecessarily.
Isn’t it conceptually the case that when someone takes an antibiotic that kills off the gut bacteria, various kinds of gut bacteria are effectively in a race to establish themselves in the “empty” gut? If C. difficile wins the race, then the problems start… So fecal transplants’ intent is to make sure that something else wins the race and occupies the gut, leaving no room for C. difficile, right?
Also— c. diff. is highly contagious in hospital settings. It is less so at home, because you really need 2 conditions to come down with infection: first, exposure to the bug, and second, antibiotic treatment to remove the healthy bacteria from the gut. I agree with taking precautions at home, but c. diff. almost never occurs without antecedent antibiotic treatment.
The transplants are to rebalance the good bacteria.
About a half a million Americans contract the disease each year and 15,000 die from c-diff. About 20-25% of these people aquire the infection outside of a hospital or inpatient center and the figure is growing. It strikes the elderly in far greater numbers.
I’m back at work today for the first time. (I took a taxi – I’m not ready for the subway yet! – and suspect that I may also not be ready for a full workday.) . It’s only been two weeks since the day I got so sick, but it felt like a month. I was able to work from home for a couple of hours each of the last two days, but it’s not the same as actually being here at the office.
Vancomycin does NOT destroy one’s hearing except rarely, when given intravenously:
https://www.rxlist.com/vancomycin-injection-side-effects-drug-center.htm. See also https://www.dizziness-and-balance.com/disorders/bilat/vancomycin.html. So I am not the least bit worried.
I had read the same thing about the vancomycin capsules being so expensive even with insurance that people have to get a pharmacist to take the intravenous solution and turn it into a liquid you can swallow (which is how it was given to me in the hospital), but after I was released, it turned out that a prescription for two weeks of vancomycin capsules (4 x 125 mg. per day) cost only $35 to fill with my insurance.
In any event, oral vancomycin is clearly not a “last resort” treatment. I was started on it, at a higher dose than I"m taking now, as soon as the C-difficile was diagnosed, and from everything I’ve read, the more recent studies show that it’s quite a bit more effective than flagyl. (With which a lot of people have adverse side effects.)
Obviously, I have been under the regular care of gastroenterologists since my Crohn’s Disease was first diagnosed 40 years ago, in November 1977, when I was in law school. So that decision was not one I had to make! Also, my gastroenterologist for the last 15 years moved from Mt. Sinai to Columbia Presbyterian a few years ago, joining the faculty of CUMC. Columbia Presbyterian happens to be the nearest hospital to where I live, so telling the ambulance where to take me was also a decision that didn’t require any time or mental energy to make. Almost every doctor I encountered at the hospital either knew him personally or knew who he was, so it wasn’t too difficult to make sure he was being consulted. When he came to see me, he made clear how common it is for Crohn’s Disease patients to get C-difficile, and to have to be hospitalized for it. So I’m very dubious regarding the statement above by a primary care physician regarding the supposedly infrequent need for hospitalization for C-diff. Perhaps CIEE83 doesn’t have too many patients with inflammatory bowel disease or other conditions that make people susceptible to this kind of infection?
Sometimes, of course, C-difficile is a known risk that gastroenterologists take in prescribing long-term antibiotic therapy. For reasons that aren’t quite understood by the medical profession, daily administration of certain antibiotics such as Ciproflaxin (as well as flagyl, ironically) is known to be quite effective in suppressing recurrences and flare-ups of Crohn’s Disease, with no reduction in effectiveness over time from any buildup of tolerance. For that reason, for the last 7 or 8 years, I had been taking 1,000 mg. per day of Cipro. For that entire time, it did nothing but help me. In fact, on several occasions when I stopped taking it for a couple of weeks for different reasons, I very quickly began to feel ill.
But eventually, it seems, things reached a point where the C-diff (which was probably already in my intestines) built up to the point, together with concomitant reduction in certain other bacteria, that I became very ill, very suddenly. (The morning of the day I fell ill: I was perfectly fine. That afternoon: from one minute to the next, I felt deathly ill and feverish and had horrible stomach cramps I almost collapsed on the subway platform at Grand Central Station. It’s a good thing I was with someone who was able to help me. I thought at first it was some kind of food poisoning from a lunch that was ordered in to a meeting at another law firm, but the doctors all assured me that you don’t get a c-diff infection from food!
In any event, I think 7 or 8 years of keeping me relatively healthy, in exchange for eventually getting a C-diff infection (as awful as that was) was probably a trade-off worth making.
Now, obviously, I’m not taking cipro anymore. I have an appointment next week, after I finish the course of vancomycin, discuss treatment for the Crohn’s going forward.
As far as helping to prevent another bout with C-diff with probiotics, I’ll bring it up, but not one single doctor I saw mentioned it as an option. Perhaps none of them believes in it.
I went back to work a week ago Friday, but by Tuesday I somehow managed to get sick again, with the most severe and painful UTI I’ve ever had, so I had to stay home again for a day and a half. My doctor had no choice but to put me back on antibiotics to fix it – but assured me when I went to see him a couple of days ago that taking antibiotics for a a few days wasn’t likely to trigger another c-difficile infection right away, not after being on vancomycin for more than two weeks. (I just finished the prescription the other day.) The antibiotics relieved the UTI within 24 hours (thank goodness!), but now I’m quite nervous about getting sick again with the c-diff, the doctor’s assurances notwithstanding. It seems that my doctors and I have a difficult balance to draw.
At least I’m feeling better now, albeit still quite exhausted from everything, and still using a cane a little bit to help me walk. I’ve even gained back a few pounds. I hope I feel well enough to start taking the subway again soon, because cabs from Washington Heights to West 20th Street and back every day add up to quite an expense, even using Via (a ride-sharing black car service that cuts the cost by 50% or more, although of course it takes longer).
I asked my doctor about probiotics, and he said they can be helpful to prevent a c-diff recurrence if one has to take antibiotics for more than a couple of days, but don’t do anything to prevent it if one isn’t taking antibiotics. Still, I ordered some Florastor (containing S. boulardii – apparently, it’s a yeast rather than a bacteria, somewhat related to brewer’s yeast) so I have it just in case. It seems to be the most commonly recommended probiotic for this purpose.
No advice, but take care of yourself and rest when you can. And eat – a lot!
"ScubaDive: Rules and regulations dictate how patients are treated. Evidence based medicine. You also need a donor and extensive medical testing on the donor to be approved. "
Or you can do what many have done and treat yourself. I’ve read about that over and over and you can bet had I known about this decades ago (which of course I did not), I would have tried it myself to help my mom (I’m perfectly healthy - and she was dying anyway), rather than see my mom suffer that way. Sometimes the red tape just stands in the way.
Cured with a single dose of Flagyl? It sure didn’t work that way for my mom. I watched it, for months and months, while also caring for toddlers. Thankfully, we had a rational family doctor who was willing to try different things until it worked. It was a 2 month course of strong antibiotics that helped my mom, but she never returned to how she was before.
Hey there DonnaL, I would say “Good to see you”, but not in these circumstances. Hope you are feeling better.
Treat yourself? Care to elaborate? (I actually have heard of the fecal transplant and thought it was more common than I gather it is…but not sure how someone, exactly, self treats)
I started taking the subway again a few days ago. So far, no problems, although I still take the cane with me to help me get up staircases. But some days (like this morning), I’m still so exhausted that I just can’t make it in – I can tell that the commute would use up all the energy I have. Fortunately, my office has been good about letting me work from home sometimes. I’m a little frustrated at how long it seems to be taking to get back to normal. I have to try to remind myself that it’s still less than four weeks ago that I first got sick, and just how sick I was.
@DonnaL I’ve been lurking long enough to remember your previous experiences and am so sorry to see you get hit with this. Recovering from it is a marathon, not a sprint. Hope you feel much better soon, and that your frustration is a sign of just that. Best wishes!