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New treatment for C. diff

First new treatment for Clostridium difficile infection since the 1950s
By
WebMD UK Health News
Medically Reviewed by Dr Keith David Barnard
woman resting in hospital bed

26th June 2012 - Cases of Clostridium difficile (C. diff) infection picked up by patients in hospitals have been falling thanks to better hygiene controls. However, oweverwhen people do get infected with C. diff bacteria, doctors' treatment options have been limited.

C. diff bacteria are present naturally in the gut of around two-thirds of children and 3% of adults. However, it rarely causes problems in children or healthy adults as it is kept in check by the normal bacterial population of the intestine.

When certain antibiotics disturb the balance of bacteria in the gut, C. diff can multiply rapidly and produce toxins which cause illness such as diarrhoea and fever. Older people are most at risk from infection and most cases occur in people over 65 years old. Once present, it can spread by spores that are excreted in the faeces. C. diff was associated with around 3,000 deaths in the UK last year.

New drug

If a patient has mild or moderate symptoms of a C. diff infection (CDI) the NHS says it's best to stop taking the antibiotics that may have caused the infection as this will allow the natural 'good' bacteria to regrow in the gut. If there are more severe symptoms, one of two antibiotics are currently recommended; vancomycin or metronidazole.

The new treatment is also an antibiotic, fidaxomicin, with the trade name Dificlir. It is given orally twice a day. Fidaxomicin is said to kill the C. diff bacteria and stop spore production, whereas vancomycin inhibits its growth but doesn't kill it.

Professor Robert Masterton, Director of the Institute of Healthcare Associated Infection at the University of the West of Scotland, said in a press release from the company which makes the new treatment that fidaxomicin is: "the first new antibiotic specifically for CDI and the first treatment to show any benefit in reducing the risk of CDI recurrence. I have high hopes that it will provide a significant benefit to patients in the UK."

Relapses

The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) has identified recurrence as being the most important problem in the treatment of C. diff.

Graziella Kontkowski, of the patient organisation, C-diff Support, told us by e-mail: "Relapse is a major problem that occurs in 20 to 30% of patients. Fidaxomicin can help prevent recurrent relapses which in turn will help prevent patients suffering from possible complications associated with C. diff infection. My Grandmother, who contacted the infection, relapsed three times during a ten week period. At 93 her body was unable to fight and sadly she died as a result of CDI.

I do understand that the treatment is more expensive than what is already being used, however what we have to remember is that recurrent infection also has a major impact on the NHS budget. More importantly we have to remember the impact that relapse causes the patient and their families which in my case cost my grandmother her life."

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