Can symptoms go away/should we treat?

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Taraph
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Can symptoms go away/should we treat?

Postby Taraph » Sun Jan 06, 2019 3:41 pm

Hello all - so glad I found this forum! My 6-year-Old daughter came down with a stomach bug that went away quickly and then seemed to come back a few days later (the rest of us in the house had it mildly as well). Because her diarrhea was persistent (and she vomited a few times) during the “relapse,” I took her to the doc. They tested her for a UTI just to rule that out, and it was positive, so she was started on cefdinir/omnicef. This was on a Monday. Symptoms, especially D, persisted through Wednesday so the doc ordered a stool culture. We started her on Florastor, and literally by Thursday, stool was normal and symptoms had mostly stopped. She was also really hungry, as she hadn’t eaten much in almost two weeks.
I collected the stool after symptoms had stopped and dropped it off, and lo and behold, she tested positive for c diff - but she hasn’t had D in well over a week. Doc has prescribed Flagyl. She has been “going” 2-3 times a day, as opposed to her usual (pre-stomach bug) once a day, and I have noticed some visible mucus on the outside, but all stools are formed and I don’t really notice any out-of-the-ordinary odor. I assumed the mucus was just lingering irritation from the bug. She is still on Florastor plus I’ve added a stronger multi-strain probiotic. Every now and then she will say her tummy hurts but it never lasts and she seems fine (her energy level has returned since being sick).
One thing to add: after being on Clindymycin for cellulitis from an infected bug bite about 18 months ago, she was passing large amounts of mucus in her stool for a couple of days. It was a weekend and doc said to bring her in on Monday but I started her on strong probiotics and it cleared up and I never took her in.
I’m not sure what I’m asking, exactly, but I guess: even though she no longer has diarrhea, is it typical to treat? And, is it possible that she had it 18 months ago, when she was pooping pure mucus, and it cleared up with probiotics, but it flared the next time she was on abx? I wonder if she is a carrier, which is apparently realatively common in young kids, and the finding of c diff is incidental here.

AllisS
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Re: Can symptoms go away/should we treat?

Postby AllisS » Sun Jan 06, 2019 4:36 pm

Hi Taraph, welcome to the site. When you have a chance, please read our guidelines for all new posters; it's the first thread in the introduction.

To answer your last question: no, it's not typical (or recommended) to treat solely on the basis of a positive test result and in the absence of watery D at least three times a day for at least three days.

Clindamycin is the top-offending antibiotic for C. diff and is best avoided, unless there is absolutely no other antibiotic that would address the situation. Not being a doctor, I don't know if your daughter's cellulitis would have fit the criteria for such a situation or not. However, I've been prescribed Keflex for suspected cellulitis on a number of occasions. (I have lymphedema in one of my arms.) Though Keflex could also trigger C. diff, I've not had a problem with it, whereas clindamycin is what caused my C. diff infection (and that of numerous others on the site).

The stomach pain that your daughter has mentioned might be due to the probiotics; they can cause an array of GI symptoms. You may want to eliminate either the Florastor or the multistrain probiotic and see if she feels better. Conceivably, you could eliminate both. There's a general misimpression that probiotics are proven to prevent C. diff, but that's not the case; the evidence in their favor, so far, is largely anecdotal. With the exception of Florastor, evidence-based studies that might show the efficacy (or lack of same) of probiotics are lacking. And the Florastor-based data apply mainly to prevention of recurrence in hospitalized patients.

Your question about whether she could be a carrier has a technical answer that one of the other moderators is probably better equipped to give.

Meanwhile, I hope your daughter feels better soon.
If your illness was preceded by use of a medication, e.g., an antibiotic, please fill out an FDA Adverse Event Report at http://www.fda.gov/Safety/MedWatch/default.htm

Taraph
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Joined: Sun Jan 06, 2019 1:01 pm

Re: Can symptoms go away/should we treat?

Postby Taraph » Sun Jan 06, 2019 5:03 pm

Many thanks. I know I was rambling and unclear: she was on Clindamycin 18 months ago and had some GI issues that resolved after that. She’s been fine since then, but was put on cefnidir for a UTI in the middle of having an extender GI virus, and subsequently tested positive for c diff but this was after symptoms had resolved. In fact, we got the positive culture result today but she just had a very solid, small BM.

Her pediatrician is generally great, I’ll speak with her tomorrow about holding off on Flagyl as long as she is not having symptoms.

beth22
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Re: Can symptoms go away/should we treat?

Postby beth22 » Sun Jan 06, 2019 7:47 pm

The first line of treatment is usually just to stop the offending antibiotic and many cases clear up. Without D, I would hesitate to treat her as well and Flagyl has some pretty severe side effects for many. I would tell the pediatrician exactly what you wrote here and tell her which probiotics you are giving her as well. It sounds as if her own body has done a good job fighting this off.

Taraph
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Joined: Sun Jan 06, 2019 1:01 pm

Re: Can symptoms go away/should we treat?

Postby Taraph » Sun Jan 06, 2019 8:33 pm

Thanks so much, I really appreciate your responses! I was able to speak with our pediatrician, who thankfully said that because she is asymptomatic, she is fine holding off on Flagyl but to call right away if she starts with D again. I’m going to keep up with probiotics.

LHutz
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Re: Can symptoms go away/should we treat?

Postby LHutz » Mon Jan 07, 2019 6:13 am

Flagyl used to be the first option for treating C. Diff, but that changed in 2018. Vancomycin is now the recommended first option to treat it. And people tend to tolerate Vancomycin much better than Flagyl, which hits many people very hard with nasty side effects. If your daughter does require treatment for C.Diff you might want to talk to her doctor about prescribing Vancomycin instead of Flagyl.


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