[02-08-2012] The U.S. Food and Drug Administration (FDA) is informing the public that the use of stomach acid drugs known as proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile–associated diarrhea (CDAD). A diagnosis of CDAD should be considered for patients taking PPIs who develop diarrhea that does not improve.
Fecal Bacteriotherapy for Relapsing C. Diff in children
We have demonstrated that fecal bacteriotherapy may well prove to be a practical and effective therapy for relapsing CDI in young children. Limitations to the routine use of this strategy for children include the potential risk of transmission of unidentified infectious agents, the invasiveness of inserting a temporary nasogastric tube, the expense of screening donors for infectious diseases, and aesthetic sensibilities. Until the effectiveness and safety of the proposed protocol can be evaluated further, this strategy should be reserved for children in whom appropriate antibiotics have failed in the setting of severe or prolonged symptomatic disease, exclusion from out-of-home child care participation, or concern about potential infection of other family members, especially young children or elderly people who may have comorbid conditions.
Treating Clostridium difficile Infection with Fecal Microbiota Transplantation
Clostridium difficile infection is increasing in incidence, severity, and mortality. Treatment options are limited and appear to be losing efficacy. Recurrent disease is especially challenging; extended treatment with oral vancomycin is becoming increasingly common but is expensive. Fecal microbiota transplantation (FMT) is safe, inexpensive, and effective; according to case and small series reports, about 90% of patients are cured. We discuss the rationale, methods, and use of FMT.