OTHER IMPORTANT INFORMATION
DON’T TAKE ANTIMOTILITY DRUGS TO STOP DIARRHEA
It may be tempting to take something like Immodium to put a stop to C. diff diarrhea, but such antimotility drugs can actually do more harm than good.
IDSA and SHEA caution against the use of antimotility agents because of a history of bad outcomes when prescribed without consideration of CDI-specific treatment, and limited data on their use adjunctively with antibiotics.
ACG also recommends against the use of these drugs for the same reasons, citing the possibility of complications or fatality when administered alone without appropriate antibiotics, and no decrease in the duration of symptoms even when administered alongside antibiotics like vancomycin or metronidazole.
STOP TAKING ANTI-ACID DRUGS
While IDSA and SHEA have reported that there is insufficient evidence to suggest discontinuing use of proton-pump inhibitors, powerful anti-acids usually taken for heartburn, for the prevention of CDI, ACG does recommend the discontinuation of these therapies in CDI patients. See here a list of commonly used GERD drugs, and talk to your doctor if you take an antisecretory drug and have, or are at risk for, CDI.
STOP TAKING ANY OTHER ANTIBIOTICS
IDSA and SHEA recommend the discontinuation of the antibiotics which may have caused a patient’s C. diff infection.
Because C. diff infection (CDI) is frequently seen in individuals taking antibiotic medications to treat other infections, it is important to stop taking all antibiotics other than those prescribed by the doctor to treat CDI (the doctor will explain which antibiotics to take and which to stop). This is because taking other antibiotics simultaneously as those used to treat CDI can reduce the effectiveness of the antibiotics used for CDI.
COMMON COMORBIDITIES THAT MAY POSE AN ISSUE: IBD AND PREGNANCY
Pregnancy often comes with more frequent visits to healthcare facilities, use of antibiotics, and other conditions that can increase a person’s risk of contracting CDI—and rates of CDI in people who are pregnant have increased over the past 20 years. C. diff can pose significant risk to a pregnant patient, so talk to your healthcare provider if you’re pregnant and experiencing symptoms of CDI.
There are some specific clinical guidelines available for patients with other conditions like those who are pregnant or have an IBD. Follow the links below if you need help finding guidelines that more closely represent your or your loved one’s medical history.
- Infectious Diseases Society of America Clinical Practice Guidelines
- American College of Gastroenterology Guidelines
- American Gastroenterological Association Guidelines
PROBIOTICS: A MIXED BAG
IDSA and SHEA, as of their 2017 guidelines update, do not recommend use of probiotics to prevent C. diff due to insufficient data. No mention of probiotics was included in their 2021 focused update.
ACG explicitly recommends against the use of probiotics for the prevention of CDI in patients being treated with antibiotics, as well as for the prevention of recurrence. The reasoning for this recommendation is the low quality of evidence to demonstrate the benefits of probiotics, suboptimal quality control for the manufacture of probiotics, and the limitations of FDA oversight on probiotics due to their dietary supplement classification. ACG also advises caution against probiotics’ use in immunocompromised patients and those with structural heart disease or central venous catheters, and states that their use may impede the healthy recolonization of the gut microbiome following antibiotic courses.
Many patients informally report success in preventing recurrence by using probiotics (specifically probiotics containing the yeast Saccharomyces boulardii), but it’s important to note that these probiotics may not work for everyone—especially with the possibility of adverse effects as stated by ACG. The gut microbiome is an incredibly complex ecosystem and different in each individual’s body, so only you and your healthcare provider can decide if probiotics are a good choice for you.
FULMINANT C. DIFF
According to IDSA/SHEA’s guidelines, the definition of fulminant CDI includes hypotension (low blood pressure) or shock, ileus, and megacolon (an abnormally enlarged colon). ACG states that this definition, while “less-than-perfect,” is the simplest and most likely to be applied broadly, and thus mirrors the recommendation.
Please note that while PLF is sponsored by many of the manufacturers or facilitators of C. diff therapies, the mention of any drugs on our website is purely for educational purposes. This site is reviewed for medical accuracy by our impartial Scientific Advisory Council and does not indicate preferential treatment for our financial supporters.