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What is Clostridium Difficile (C.difficile)? Clostridium difficile, or C. difficile (a gram-positive anaerobic bacterium), is now recognized as the major causative agent of colitis (inflammation of the colon) and diarrhea that may occur following antibiotic intake. C. difficile infection represents one of the most common hospital (nosocomial) infections around the world. Laboratory studies show that when C. difficile colonize the gut, they release two potent toxins, toxin A and toxin B, which bind to certain receptors in the lining of the colon and ultimately cause diarrhea and inflammation of the large intestine, or colon (colitis). This bacterium is primarily acquired in hospitals and chronic care facilities following antibiotic therapy (symptoms may be delayed until 6-8 weeks after antibiotic use). In addition to antibiotic use, chemotherapy and hospitalization, another risk factor for developing C.difficile diarrhea is simply advancing age. One study conducted in Sweden found that individuals older than 60 years of age are 20 to 100 times more likely to have C.difficile in their stools compared to 10-20 year olds (Barlett, 2002). What are the symptoms of C.difficile? Symptoms of C.difficile diarrhea vary widely in severity. Some individuals experience recurrent mild-to-moderate diarrhea, wither others suffer from recurrent bouts of severe abdominal and back cramping, frequent loose and watery, greenish, foul-smelling stools, flatulence, fever, as well as variable amounts of mucus and blood in the stool. C.difficile diarrhea with accompanying inflammation of the colon can lead to toxic dilation of the colon, perforation of the colon, dehydration, loss of water volume, shock, and death. The toxins produced by C.difficile can also trigger a whole host of extra-intestinal complications, including joint pain and sleep disorders. How can C.difficile be treated effectively? Although C. difficile infection usually responds to antibiotic treatment with metronidazole or vancomycin, approximately 20 to 25% of patients will experience re-appearance of diarrhea and other symptoms weeks or even months after initial therapy has been discontinued. When antibiotics are used to eradicate C.difficile, the antibiotics kill many of the “good” gastrointestinal flora species, but only kill non-spore forms of C.difficile. The C.difficile spores are still present. In order to eliminate C.difficile spores you need to have some “good” normal flora present. How can I re-establish my gastrointestinal flora to eliminate C.difficile? Numerous of studies have proven certain probiotics to be a successful solution for recurrent C.difficile diarrhea. Saccharomyces boulardii Saccharomyces boulardii is a non-disease causing yeast that survives passage through the intestinal tract, unaffected by antibiotics (although it will be killed by antifungal drugs). Based on preliminary data indicating that this yeast could prevent antibiotic-associated diarrhea, numerous studies, have gone on to prove Saccharomyces boulardii, as an effective treatment for active C.difficile diarrhea. Saccharomyces boulardii disrupts toxins that would normally irritate the intestines and by doing so has cured many people when conventional medicine has failed. In addition, Saccharomyces boulardii stimulates the intestinal immune system to secrete C.difficile toxin A-specific antibodies (IgA) in the gut (Qamar et al., 2001). Lactobacillus GG Lactobacillus GG given at high doses (10 billion live bacteria daily) for as little as 7-10 days following traditional antibiotic therapy (metronidazole or vancomycin) has cured patients with relapsing C.difficile diarrhea (Gorbach et al. 1987). Lactobacillus GG is resistant to gastric and bile acids, it can adhere to and colonize the gastrointestinal tract and it produces antimicrobial substance that inhibits growth of other anaerobic bacteria in the gut. Numerous studies have been conducted using various probiotic regimens and results indicate that Lactobacillus GG and Lactobacillus plantarum may be effective treatments for recurrent, relapsing C.difficile diarrhea (Biller et. Al.,1995;Levy et al.,1997) When it comes to probiotics in the gastrointestinal tract, experts now agree on two things: a critical number of microorganisms must be consumed in order to alter the bacterial population in the gut, and several different species of bacteria given simultaneously are preferable to using just one species, in order to exert positive effects. References: 1. Bartlett J. Antibiotic-associated diarrhea. NEJM. 2002;346:334-339. 2. Biller JA, Katz AJ, Flores AF et al. Treatment of recurrent Clostridium difficile colitis with Lactobacillus GG. J Pediatr Gastreoenterol Nutr. 1995;21:224-226 3. Gorbach SL, Chang T-W, Glodin B. Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet. 1987;2:1519 4. Karpa K. Bacteria for Breakfast Probiotics for Good Health. Trafford. 2003; 105-115 5. Levy J. Experience with live Lactobacillus plantarum 299v; A promising adjunct in the management of recurrent Clostridium difficile infection. Gasroenterology.1997;112:A379 6. Qamar A. Aboudola S, Warny M, et al. Saccharomyces boulardii stimulates intestinal immunoglobulin A immune response to Clostridium difficile toxin A in mice. Infect Immun. 2001;69:2672-2765