Flaygl question help!

[Lalabell]

Hi everyone!

My 4 year old was diagnosed with CDiff last weak and was started in flaygl 250mg 3x a day for 14 days she also takes floraster 2x a day. Tomorrow will be day 10 of flaygl. Since she has been on the medication her stools have been sometimes harder and formed and sometimes soft mush that disintegrated when flushed. There is no more mucus in her stool which there was a TON of before she began the meds. She is still going to the bathroom between 1 and 4x a day. I am just not sure what I am supposed to expect. Should I be seeing her normal pre cdiff stools while she is on the medication? Or is it normal to still have some loose mushy stools?

I am just so worried! She is currently being treated by her ped who has said he has delt with many children who have had cdiff and most get better on the flaygl and some need to move onto the Vanco. I have an apt scheduled with a ped gastro for this coming Tuesday. But in the mean time would love some words of wisdom from those who have been down this road.

Thanks so much!

[beth22]

Hi Lalabell and welcome to the site. Please read the first forum for more information for new posters.

I'm sorry that your little one has to deal with c difficile. I am surprised that the pediatrician treated her with Flagyl as it is no longer recommended. Hopefully, the Flagyl worked and it doesn't sound as if she had many side effects from it. If the infection returns, I would definitely ask for vanco.

You really won't know until she is off the meds for a while if the Flagyl worked or not. Flagyl in and of itself can give D or mushy stools. It does take the body a while to recuperate. Seeing a ped GI is also a good idea. The fact that she is no longer having M is also a good sign.

[sammyp]

For reference I think Flagyl is still recommended for children if I recall correctly and the Vanco if there is a relapse :)

[roy]

Guidlines say.
"As opposed to adults, metronidazole can still be considered for treatment of an initial or first recurrence of mild/moderate CDI in children."

My opinion.
Thats Probably so that theres still 2 choices of antibiotic because Dificid is still in phase 3 trials for children and not yet approved.
Many Drs still use Dificid in children though.
Flagyl is equal to vanco and dificid at killing c.diff and halting D.
The reason its inferior is that adult patients relapse a lot more often if flagyl is used.
Hopefully children are tougher and bounce back quickly!

[Lalabell]

Thank you for responding!! That is exactly what’s ped said when I asked to switch her over to the Vanco he said that in children flaygl is still the first line of treatment and that if it is unsuccessful she will be put on Vanco. I do feel that the mucus going away is a good sign it’s just so challenging to know if she is getting better because there is still loose stool. This has just been so terrifying! My ped said we can retest her about 4 days after she stops the medication however, I read that we should not retest for a cured I just don’t know what to do :(

[roy]

A retest is a BAD idea!
Only symptoms say it's gone.
She could test positive for quite a while.
The aim is not to get a negative test or even to clear 100% of the bacteria.
What your aiming for is a reduction in the bacteria to the point where the body's natural immunity takes over and stops reacting to the toxin.
No host response means theres no disease and no treatment needed.

[beth22]

Testing 4 days later is really too soon. I would continue to give her the probiotics after you stop the Flagyl and see how she does. I would not re-test unless her symptoms return.

[Lalabell]

Ok thank you!! I will wait and see hopefully the diarrhea doesn’t return.

[roy]

C.diff protects itself when it's under threat by antibiotics.
It builds a coat of armour and becomes a spore untill the threat is gone.
When it detects theres no antibiotic in the gut it germinates and the cycle starts again
Spores do not show up on any of the tests.
If a test is done 4 days after finishing meds the spores will not have germinated so a negative test is the result.
a few days later they germinate and it's back but the negative test confuses the Dr and treatment is delayed.
Opposite is the fact that c.diff DNA can linger in the gut for weeks after treatment and the VERY sensative test picks it up.
A test of cure is VERY unreliable, only symptoms say if it's gone.

[Lalabell]

I am nervous to just stop the flaygl after the 14 days. Do they do a taper with flaygl? At my GI appointment on Tuesday should I ask to switch her over to the vanco? I just want this gone! My poor baby has been suffering for so long it is so scary and heart breaking

[roy]

She has to come off meds so that her good gut flora can regrow.
Overtreating can make it worse, not better.
The least amount of treatment that resolves c.diff means the lower the chances of a relapse.
Finish the meds, keep up the probiotics for a while (months) and with average luck its dealt with.
Dont over do probiotics though.
Let her play as normal and pick up all those good bugs:-)

[Lalabell]

Thank you Roy!! This poor kid needs all the good bugs she can get :)