May 2008

Q. Mom, who is 92, fell and broke her hip in mid Feb. She recovered well from her surgery and was soon transferred to a rehab facility for an additional 5 week rehab while she progressed in weight bearing. She was ill with a chest infection and placed on antibiotics and wouldn't you know it she contracted CDiff. Flagyl was ineffective so she was placed on Vanco. She did 2 courses of Vanco with a week off in between. She then was feeling well, had formed stools for approx. 1 week and then started up again with diarrhea which she described as being the same as her initial onset. She has been on probiotics and has recently started on saccharomyces boulardii. She just finished another 7 day course of Vanco and though she is afebrile, no cramping, is maintaining a relatively soluble fiber diet, the diarrhea persists. Any other suggestions? She has lost approx 20#. She generally feels well though tired. She continues to live independently and is driving(!!).

A. Vancomycin almost certainly will eliminate the toxin with time but can be tough and persistent. Has she had a follow up c diff toxin titer to confirm she is clear? Her bowel may not be normal for some time but doesn't necessarily mean she still has the toxin. Acidophillus/probiotics may help and certainly can't hurt in any way. I am sure she was told to avoid anti-diarrhea medications like immodium because they can prolong things/make things worse.