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Suggest schedules and regimens for treating C. diff infection?

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General Surgeon
Practicing since : 2008
Answered : 1290 Questions
hi I am a nurse and just recenty I was diagnosed with c diff.. I was put on flagyl 500 tid for 10 days. I started taking probiotics along with it. 2 -30 billion a day.' I have no diarrhea... my stools are good... except this am.. I had two very formed movements.. then a much looser bm... no diarrhea... just not as formed... then later in the day... I noticed i felt chills... and the body odor changed. I read on the internet a schedule that sounded good... taking flagyl week 1- bid, week 2 od, week 3 every other day, and week 4 twice weekly, week 5- once a week... I like this schedule... my own doctor did not agree with it.. what do you think of this schedule?
Posted Fri, 31 Jan 2014 in Digestion and Bowels
Answered by Dr. Ashish Verma 1 hour later
Brief Answer: your treating doctor is right Detailed Answer: Hi XXXXXXX Thanks for writing to XXXXXXX This is Dr. Ashish Verma, a general surgeon, answering to your query. Though there are various schedules and regimens for treating C.diff...the Society of Healthcare Epidemology of XXXXXXX (SHEA) and the Infectious Disease Society of XXXXXXX (IDSA) indicate that meronidazole (500 mg PO TID for 10-14 days) is the drug of choice in these patients. And so what your doctor gave you was totally right. Frankly speaking, i have also not read of that internet schedule in any book, so i will also advise you against it. But the thing with C.diff associated colotis is that, the relapse is generally common, occurring in up to 20-27% of cases, occurring typically in 3 days to 3 weeks after the treatment is discontinued. Possible reasons for it include ongoing risk factors like antiobiotic exposure, failure to eradicate the organism from the colon and reinfection from the environment. As per my practice, for the first relapse, to my patients i prescribe them the same medicines as for the initial episode, if it is not severe. But for subsequent recurrence, i manage them with vancomycin therapy. As yours is first relapse, and not a severe one, i would suggest that you repeat the same course again, but this time for 14 days. Hope i have answered all your queries. If you have further queries, i will be glad to answer them. Get Well Soon! Dr. Ashish Verma
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