My first post, I'm a 43 yr old male from the midwest and I first got mild/moderate CDI late last year after being prescribed Augmentin for ear infections. I had a standard round of vanco (or was it 2 rounds?) and then I suggested the tapered or pusled regimen to my doc. I also took Floraster once daily. About a week after I finished the tapered regimen I had a sudden and very painful relapse. I took the vanco I had left over 5 days (they prescribed more than I needed for the tapered schedule for some reason and so I had extra) and started doubling up on Floraster. Its been 3-4 days since my last vanco and I'm dreading if it will return. The following is really nerdy, but I wanted to understand it because I'm frankly tired of dealing with it.
In the meantime, I've been researching so that I can understand how this works. I wanted to know what triggered the sprores (or the whole process really). The best info I could find was 'bile acids'. I came across an interesting finding by Norman B. Javitt, MD, PhD, research professor of medicine and pediatrics at NYU School of Medicine. (https://med.nyu.edu/faculty/norman-b-javitt) the short of it is that he found that by having patients taking Actigall, it appears to resolve occurrence and relapse of CDI (in his tests/trial). It appears to work because it stops spore germination. That's what I understand at least. Granted, perhaps the trial was small and there may be other considerations.
He also spoke last fall with the FDA:
"...The reason the spores remain dormant is the presence of bile acids that suppress C. difficile germination as explained in this slide.
Normally, the liver produces what are generally referred to as primary conjugated bile salts, or acids. These are metabolized of cholesterol and
provide a major pathway for removing cholesterol from plasma. When the gallbladder contracts after a meal and the primary conjugated bile salts
enter the intestine and reach the colon, there are two bacterial enzymes produced by the normal gut microbiome that convert the primary conjugated bile salts to unconjugated secondary bile acids. These secondary or intestinal bile acids, deoxycholic acid and lithocholic acid, suppress the germination of C. difficile spores...."
"...The impact of some antibiotics on the formation of secondary bile acids is shown in this slide. Antibiotics can suppress or even eliminate the normal intestinal bacteria that produce bile salt hydrolase and 70 hydratase, which prevents the formation of secondary bile acids. Without the suppressive effect of the secondary bile acids, dormant C. difficile spores begin to germinate and produce the toxins that lead to C. difficile infection. What makes matters worse is that the primary conjugated bile salts actually stimulate the germination of C. Difficile..."
I didn't find anything on this type of therapy. Has anyone done this? I'm going to have a heck of a time trying to get my doc to go for this I think.
Treatments, possible treatments, unsubstantiated/unproven treatments. Consult your doctor first.
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I would print out the literature and fax it to your doctor or show it to him in person if you go for a visit. Seeing something in print makes more of an impression than if you just report it.
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