Heather's case history

Guest · Postby **Guest** » Wed Jan 08, 2003 5:07 pm

5 months ago (July) I was put on Augmentin (ammoxicillin + clavulinate) for 2 weeks (long dose). Halfway through, I got what seemed like food poisoning, one day of vomiting and a pretty quick recovery... but couldn't figure out what could have caused any problem. a month and a half later (Sept) I woke up suddenly and had to go RIGHT NOW. I ran to the bathroom, and instead of feces, there was just a lot of mucous and blood. I went to the Dr. that afternoon, and a stool sample confirmed C. Diff infection. I am a microbiologist and hate the idea of taking a last-recourse antibiotic, so I asked to have flagyl (metronidazole) instead of vancomycin. I also took daily saccharomyces boulardii and acidophilus probiotics, missing a couple of doses. I went on a 2 week course (250mg tid), felt better in 2 days, and after the 13 days were over ( I missed the last day because I was just too dizzy and nauseous on the flagyl, and my doc thought 1 day wouldn't make a big difference considering that 10 days is a usual course) woke up 3 days later to blood and mucus. It was a saturday morning, and I was pretty crampy and had alot of watery diarrhea, so I took the 3 flagyl I had left sunday, and went to the doc monday. My stool sample was neg for c. diff, but probably just because of the day of flagyl on sunday. By the time I found out, I was halfway through my next 2 weeks of flagyl, and had responded. Because the bug was still responding to the antibiotic, it was my belief that the recurrance was probably due to the spores that weren't killed in the first 2 weeks germinating after I went off flagyl. I also used s. boulardii this time, but wasn't very good about it. I once again imporved markedly, and this time it was 2 weeks before I relapsed. I was pretty depressed, and read up a LOT, and found the review article "Treatment of Clostridium difficile associated diarrhea, Malnick, s.d and Zimhony, O, Annals of Pharmacotherapy, 2002, 36:1767-1775" Which discussed a tapered pulse dosing of antibiotics for the second relapse. This had been tried with vancomycin, but was suggested with vanco or flagyl. The plan was, after 2 treatments with 2 weeks of antibiotic, if there was another relapse, you should then take full dose for 1 week (4x125mg for vanco or 3x250mg flagyl daily) then half that for a week (2x125 vanco or 2x125 flagyl) Then halve it again (1x125 vanco or 1x250 flagyl per day) for another week. In the fourth week, you only take 1 dose every other day, and in the fifth and sixth weeks you take a dose every third day. In the trial with people who had previously relapsed with C. diff multiple times, all 22 responded to this treatment method (with vanco), and in a mean follow up time of 6 months (varying from 2-12 months) there were 0 relapses. This sounded very promising. I brought this to my doc, and she agreed that we should give it a try. I was very hopeful, and asked for flagyl again, promising that if it didn't work, I'd take vanco. I followed the regimen very closely, missing 1 dose, and taking 1 of the last 3 doses a day late (it's pretty confusing) I also took saccharomyces boulardii, but they seemed to give me very loose stools, so I only took one tabled every couple of days instead of 1-3 prer day. I also took acidophilus in a meek attempt to re-colonize my gut. So, here I am, It's now January, two weeks since my last flagyl and starting vanco for my fourth C. diff infection, third relapse. Harrumph. I have a referral to a C. diff specialist, and hopefully she will have better ideas. I'm still doing the s. boulardii at a higher dose after reading more encouraging reports, and hoping for the best. I'll update if/when things change... [Guest Posted by: 'heather']

Guest · Postby **Guest** » Sun Feb 02, 2003 1:48 am

Brief update, I finished the vanco, and did a lot of looking into probiotics... I decided that a lot of acidophilus, some rhamnosus, and some saccharomyces boulardii seemed to work for a lot of people I read about, so I decided to give it a try. I've been taking 2 /s boulardii (Jarrow) 3 primadophilus rueteri (Nature's way: includes rhamnosus, reuteri, and acidophilus) and 2-3 primadophilus bifidus (also nature's way: including Bifidobacterium breve and longum, and Lacotbacillus rhamnosus and acidophilus). I took this 2-3 times a day. 3 times a day only when I hadn't slept enough and was getting diarrhea. I chose the dose because I read several reports claiming that none of these bactera or the yeast could take over and cause a problem. Apparrently, the S. boulardii did take over in one patient, but she was given an antifungal, and was fine... and the antifungal shouldn't cause C. diff to return, so I didn't worry too much about that, but did keep the dose low. I also read a study using 500mg of acidophilus several times a day in patients until it took over as a major part of the colonic flora, so that would be 10 of any of the capsules I had, so I decided half that dose should be okay. They also oddly said that you know you have enough acidophilus because the feces become bulkier and lack odor, which I thought was probably a little silly. For the first time since getting this nasty bug, I've passed my magical 12 day relapse...but just barely. Hoping hoping hoping. I feel better than I have since this whole thing began. I'm very hopeful that I can beat it this time without antibiotics. crossed fingers!! I'll let you all know! [Guest Posted by: 'heather']

Guest · Postby **Guest** » Sun Feb 23, 2003 4:16 am

one month without antibiotics and counting, 8 weeks pregnant, and nervous about a relapse, and a negative stool sample one week ago. I've had my share of grumblies and irregularities recently, but have been reassured to find that other people had similar problems after their C. diff was gone. Morning sickness is laughably similar to Flagyl, except that I don't allow myself to just not eat now. I was taking the probiotics for a month, and cut way back because swallowing that many pills in addition to vitamins was making me sick most of the morning.I also think a lot of my other grumblies could be due to the digestive tract upset associated with pregnancy. The characteristic burning pain, and the unmistakeable early morning rush to the bathroom to pass nothing but blood and mucous haven't happened this time, which is a first, so that makes me hopeful at least! At one point, I did think I had a relapse. I did have the pain, but the constipation never resolved to diarrhea, and the blood never showed up... but the mucous and the burning were a little disconcerting. I still think it had to have been C.diff, but I felt better in 3 days on my own, and a stool sample on the 4th day was negative. I have always gotten + tests before (except while taking antibiotics already) even when I was constipated, so I actually trust the test this time. At this point, I'm very hopeful, but still waiting to see what happens. Ironically, I finally was referred to a GI specialist 2 weeks ago, it would be okay with me to not make good use of her specialty though. I'm hoping it doesn't come back anytime soon... time will tell! [Guest Posted by: 'Heather']

Heather's case history

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