On Clostridium Difficile

Get out your blenders. Today I attended a lunchtime lecture given by Dr. Jessica Allegretti, a Brigham gastroenterologist who specializes in recurrent Clostridium difficile and fecal microbiota transplants (FMT). I don’t think I need to review the burden of disease caused by C diff, as most readers of my blog probably are aware that C diff is a major problem. The “hypervirulent strain” (NAP1/BI/027) of C diff which causes severe pseudomembranous colitis is also concerning (although NAP1 has been on the decline since 2007).  Recurrences of C diff are common and the medications we use most often, metronidazole and vancomycin, are frequently ineffective. In addition, fidaxomicin, a second line medication, is very expensive. In her lecture, Dr. Allegretti commented that “unnecessary antibiotics are rampant” in the community causing recurrent C diff. As a result, she is busy doing traditional FMT (hence the blender comment). She is also performing transplants via frozen capsules. Her frozen capsules are compounded at MIT and are given 2 days in a row in the office (30 capsules each day). Dr. Allegretti reports that the majority of patients have a rapid reversal of symptoms within 24 hours and are cured. That’s good to hear, but I think it’s a sad state of affairs when C diff is common and FMT is becoming more and more necessary. There is a lack of motivation from clinicians, patients, and the health system to reduce the unnecessary use of antibiotics. As a result, people, young and old keep getting sick from C diff. Hopefully we aren’t approaching the “antibiotic winter” described by Dr. Martin Blaser.

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