Antibiotics: The Standard of Care and Predominant Risk Factor 1.5 update

Antibiotics: The Standard of Care for C. diff Infection

Is Also a Predominant Risk Factor for Recurrence

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While antibiotics are the standard of care for the treatment of C. diff infection, their use is also a predominant risk factor for recurrence. Up to 35% of patients will experience recurrence within 8 weeks after initial C. diff infection diagnosis.1,2

Antibiotic use has been shown to disrupt the ecology of the human microbiome and is associated with increased risk of deadly infections such as recurrent C. diff.3

Cycle of recurrence

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Disruption of microbiota increases the risk of C. diff infection by providing a niche for the infection to flourish. Should the intestinal microbiota be disrupted by antibiotics, the effects may be long-lasting and the risk of C. diff infection may increase during continued therapy. Longer exposure to multiple antibiotics and treatment with multiple antibiotics may increase the risk.4

Thus starts a cycle of C. diff infection and reinfection—impeding microbiome recovery, exacerbating morbidity, and creating a substantial economic burden.5

Restoring a healthy gut microbiome

Restoring a healthy gut microbiome is increasingly accepted as a promising treatment option for recurrent C. diff infection.6

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References

  1. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825-834.
  2. Cornely OA, Miller MA, Louie TJ, Crook DW, Gorbach SL. Treatment of first recurrence of Clostridium difficile Infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55(suppl 2):s154-s161.
  3. Langdon A, Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Med. 2016;8(1):39.
  4. McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66:e1-e48.
  5. Fitzpatrick F, Barbut F. Breaking the cycle of recurrent Clostridium difficile infections. Clin Microbiol Infect. 2012;18(suppl 6):2-4
  6. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368(5):407-415.