Sunday, March 21, 2010

Probiotics and clostridia difficile

I noticed a disturbing item in this a.m.'s paper--diarrheal illnesses caused by clostridia difficile are increasing in number and virulence. This serious intestinal condition is now more common than disease caused by methicillin resistant staph aureus aka MRSA as a cause of serious hospital-acquired infections.

C. diff tends to be a nosocomial infection, i.e. one that results from medical treatment, specifically, in this case, from the use of potent antibiotics. C. diff is not normally present in the gastrointestinal tract but moves into the territory after antibiotics kill off the good little bacteria who normally call our colons home. Increasingly virulent strains of c. diff can cause life-threatening colitis which occasionally requires emergency surgery, sepsis (overwhelming infection), and death.

While community-acquired C. diff rarely causes serious illness, it can run on and on in unpleasant and debilitating ways. Research suggests that the use of probiotics --preparations available over-the-counter that contain live bacteria of the intestinal-friendly variety-- can decrease the risk of antibiotic-related diarrhea including C. diff. While the use of these supplements is not recommended as the sole treatment of the condition, they may in fact promote a healthier micro-environment in the colon which increases resistance to a C. diff invasion.

I often recommend probiotics to my patients starting antibiotics for acute bacterial illness. I was interested, therefore, in a recent review by Consumer Lab of the various products on the market. Consumer Lab conducts testing on various over-the-counter nutritional supplements, including a review of the scientific literature for supporting information on their legitimate uses as well as a summary of testing results for purity and truth-in-labeling. Their nominal annual fee is well worth the price for consumers interested in using such products.

In the "you can't always get what you think you do" world of label-reading, I discovered that two of the probiotic products I recommend by name--Culturelle and Align--did not deliver the promised organisms per capsule. There is quite an in-depth discussion of probiotics on this site, and I recommend it to you as vital information concerning the increasingly perilous world of microbes, anti-microbes, and the pro-microbes that defeat them.


kenju said...

Woohoo - I many be doing something right! I started taking probiotics (Phillips Colon Health) about 2 weeks ago and it has helped me a lot. Now I'll have to check to see if it delivers what it says!

I had a good friend die of C.Diff after a stay in a hospital. It was devastating to the family because it was so unexpected.

Mauigirl said...

My aunt got it after she had an operation and had been on antibiotics. Luckily it finally did clear up. It's a nasty bug, for sure.