A recent piece inThe New York Times, "Stomach Bug Crystallizes an Antibiotic Threat" by Tara Parker-Pope (she did a nice job), prompted me to post two items:
2) Here is a piece I published in 2005 in The Voice, a health journal for undergraduate pre-medical students; the analogy I composed is novel, as far as I know:
"Clostridium Difficile: A Weed Inside Your Digestive Tract"
Cartoon depiction of a C. difficile bacterium (a.k.a. “C. Diff”)H ave you ever taken antibiotics for ear infections, sinus infections, pneumonia infections, or other types of infections? When you took these antibiotics, did you ever think that taking antibiotics could lead to another serious illness? Probably not. Unfortunately, many people do not know about the bacterium Clostridium difficile (C. difficile). This bacterium can infect your intestinal tract while you take antibiotics to treat illnesses caused by other types of bacteria.
Physicians use antibiotics to treat infections caused by bacteria. Because almost everyone will take antibiotics at some point in their lives, everyone should know about C. difficile infections. Like weeds that invade your backyard lawn, C. difficile invades your intestinal tract and then challenges the people who try to treat your infection. As you know, trying to eliminate weeds (C. difficile) from your backyard lawn (intestinal tract) is difficult. For this reason, C. difficile carries an appropriate name—difficile—because it is a difficult bacterium to eradicate.
In fact, my younger brother suffered from a C. difficile infection for more than nine months. Awhile ago, he ingested C. difficile while in a hospital for throat surgery. Following this surgery, he developed a bacterial infection in his throat that was not caused by C. difficile. To treat his throat infection, his pediatrician prescribed a series of antibiotics, starting with Clindamycin. After he took this antibiotic for its normal five to seven day course, his throat infection did not improve. So, his pediatrician prescribed amoxicillin. Unfortunately, his throat infection did not improve after taking this antibiotic. His pediatrician then prescribed augmentin, in an extra large dose. After taking augmentin, my brother experienced severe diarrhea, bloating, and abdominal pain.
“It feels like there’s a bowling ball in my stomach,” he said on numerous occasions. Once he experienced these symptoms, his physician ordered stool samples and started him on Flagyl, an antibiotic used to treat C. difficile infections. His symptoms continued, so his physician prescribed Vancocin, another antibiotic used to treat C. difficile infections. Thankfully, after two courses of Vancocin, supplemented with probiotics and some newly developed treatments, his C. difficile infection improved and then finally disappeared.
Hopefully, the information contained in the following sections will help you or someone you know avoid a C. difficile infection.
How does C. difficile infect my body?
C. difficile infects your small and large intestines after you have taken antibiotics to treat an illness caused by other types of bacteria.
A labeled illustration of the human digestive system, which includes the intestinal tract (labeled in bold), is included below:
Normally, in healthy people, “good” bacteria completely cover the inside walls of their intestinal tracts. The intestinal tract is a series of hollow tubes that food and waste pass through. “Good” bacteria live side-by-side on the inside walls of this hollow tube. In this way, the walls of your intestinal tract act as soil where “good” bacteria attach to create a healthy bacterial “lawn” inside your intestinal tract.
This “lawn” of “good” bacteria facilitates two important processes that occur in your intestinal tract:
• absorption of nutrients from the food you eat
• removal of wastes from your body
To work effectively, “good” bacteria completely cover the total surface area of the inside walls of your intestinal tract. This lush bacterial “lawn” is thick enough to create a physical barrier that prevents “bad” bacteria, such as C. difficile, from living inside your intestinal tract (illustrated below):
Unfortunately, when you get sick with bacterial infections, many of the antibiotics that physicians prescribe for your illnesses cannot target and kill only the “bad” bacteria that have caused your illnesses. These antibiotics will also kill some “good” bacteria in your body, especially in your intestinal tract.
In this way, these antibiotics function like weed killers. When you use weed killers to destroy weeds in your backyard lawn, the weed killers eliminate most of your weeds, but, at the same time, they also kill some of your precious grasses.
The illustration below depicts this comparison between weed killers and antibiotics:
By removing some of the “good” bacteria from your intestinal tract, antibiotics create open spaces along the walls of your intestinal tract that C. difficile bacteria can invade.
When C. difficile bacteria attach to the walls of your intestinal tract, they start producing toxins A and B. Your body’s response to these toxins causes the symptoms of a C. difficile infection.
The process that leads to a C. difficile infection is illustrated below:
Usually, very few C. difficile bacteria live in your body. However, if you receive antibiotics during or after a hospital visit, your chance of contracting a C. difficile infection increases tremendously since the microscopic C. difficile bacteria live on hospital walls and equipment.
What are the symptoms of a C. difficile infection? Symptoms of a C. difficile infection will appear either while taking a prescribed course of antibiotics or shortly after finishing a prescribed course of antibiotics. These symptoms result from your body’s natural reactions to the toxins that C. difficile bacteria release inside your intestinal tract.
Patients with C. difficile infections often experience one or more of the following symptoms:
• diarrhea (most common)
• bloating
• abdominal pain
• gas
• inflammation of the colon (most severe)
How does a physician diagnose and treat a C. difficile infection?Diagnosis .
Physicians generally use two tests to diagnose C. difficile infections:
• stool sample
• breathe test
These laboratory tests either check for the toxins (A and B) that C. difficile produces or for a chemical that your body produces in response to C. difficile.
Treatment.
Since C. difficile acts like a weed in your intestinal tract’s “lawn” of “good” bacteria, physicians use a process to eliminate C. difficile from your body that is similar to the process you would use to eradicate weeds from your backyard lawn.
To eradicate weeds in your backyard lawn, first you would use weed killers to kill all the weeds that have invaded your backyard lawn. Then, you would reseed your lawn with “good” grasses, like Kentucky bluegrass.
This same approach applies to treating C. difficile: first, use antibiotics to kill all the C. difficile bacteria that have invaded your intestinal tract; then, reestablish the “good” bacteria on the inside walls of your intestinal tract by taking probiotics. Probiotics are capsules filled with “good” intestinal bacteria, such as Lactobacillus.
By killing the C. difficile bacteria that had infected your intestinal tract, antibiotics create empty spaces on the inside walls of your intestinal tract. The “good” bacteria contained in probiotics move into these spaces and reestablish a thick “lawn” of healthy bacteria on the inside walls of your intestinal tract that prevents C. difficile from infecting your body again.
Currently, physicians prescribe two antibiotics, Flagyl or Vancocin, to kill C. difficile bacteria. Probiotics can be purchased at nutrition stores or prescribed by physicians.
Preventing a C. difficile infection
The three best ways to prevent a C. difficile infection are:
• recognize that most people contract C. difficile while in the hospital
• limit prolonged exposure to antibiotics
• avoid antidiarrheal medications when you have diarrhea after taking antibiotics
First, concern for a C. difficile infection should increase whenever someone receives antibiotics while in a hospital.
Second, prolonged exposure to antibiotics, if possible, should be avoided. The longer people are exposed to antibiotics, the more “good” bacteria that the antibiotics will kill in their intestinal tracts. Nonetheless, when patients suffer from severe illnesses or acute infections, their physician’s may feel that taking antibiotics for longer than normal is necessary. In these cases, physicians should be consulted to find out whether avoiding prolonged exposure to antibiotics is appropriate.
Third, over-the-counter antidiarrheal medications should not be used to treat diarrhea while taking antibiotics or immediately after taking antibiotics because antidiarrheal medicines slow down your body’s ability to remove toxins A and B. In this case, diarrhea is your body’s natural response to these toxins because your body wants to eliminate these toxins.
Conclusion: the take-home message
In order to avoid C. difficile infections, patients must closely examine and monitor the antibiotic treatments that they receive. Whenever patients take antibiotics for longer than normal, especially if these antibiotics are taken while hospitalized, patients should discuss with their physicians the possibility of developing a C. difficile infection in order to remind their physicians to consider C. difficile as a potential side effect to taking antibiotics.
However, if a C. difficile infection develops, patients should not lose hope because their infections will heal with time. The healing process will probably take at least six months. Although six months is a long time, current research on C. difficile should lead to the development of more effective methods for treating C. difficile infections.
In my brother’s case, our mom located a physician at Cedars Sinai hospital in Los Angeles who researches C. difficile and who cured Sean’s infection by prescribing some new C. difficile treatments. One of the treatments that this doctor prescribed was a ten-day diet of only Vivonex. Vivonex is a liquid that contains nutrients but lacks sugar, so it killed the sugar-dependent C. difficile bacteria in his body by “starving” them to death. Thankfully, this physician turned out to be a cutting-edge “horticulturist” who knows how to kill weeds and grow thick grass!
Reference
Schroeder, Michael S., M.D., “Clostridium difficile—Associated Diarrhea.” American Family Physician 71.5 (2005): 921-928. 22 April 2005 .
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Cartoon depiction of a C. difficile bacterium (a.k.a. “C. Diff”)
H ave you ever taken antibiotics for ear infections, sinus infections, pneumonia infections, or other types of infections? When you took these antibiotics, did you ever think that taking antibiotics could lead to another serious illness? Probably not. Unfortunately, many people do not know about the bacterium Clostridium difficile (C. difficile). This bacterium can infect your intestinal tract while you take antibiotics to treat illnesses caused by other types of bacteria.
Physicians use antibiotics to treat infections caused by bacteria. Because almost everyone will take antibiotics at some point in their lives, everyone should know about C. difficile infections. Like weeds that invade your backyard lawn, C. difficile invades your intestinal tract and then challenges the people who try to treat your infection. As you know, trying to eliminate weeds (C. difficile) from your backyard lawn (intestinal tract) is difficult. For this reason, C. difficile carries an appropriate name—difficile—because it is a difficult bacterium to eradicate.
In fact, my younger brother suffered from a C. difficile infection for more than nine months. Awhile ago, he ingested C. difficile while in a hospital for throat surgery. Following this surgery, he developed a bacterial infection in his throat that was not caused by C. difficile. To treat his throat infection, his pediatrician prescribed a series of antibiotics, starting with Clindamycin. After he took this antibiotic for its normal five to seven day course, his throat infection did not improve. So, his pediatrician prescribed amoxicillin. Unfortunately, his throat infection did not improve after taking this antibiotic. His pediatrician then prescribed augmentin, in an extra large dose. After taking augmentin, my brother experienced severe diarrhea, bloating, and abdominal pain.
“It feels like there’s a bowling ball in my stomach,” he said on numerous occasions. Once he experienced these symptoms, his physician ordered stool samples and started him on Flagyl, an antibiotic used to treat C. difficile infections. His symptoms continued, so his physician prescribed Vancocin, another antibiotic used to treat C. difficile infections. Thankfully, after two courses of Vancocin, supplemented with probiotics and some newly developed treatments, his C. difficile infection improved and then finally disappeared.
Hopefully, the information contained in the following sections will help you or someone you know avoid a C. difficile infection.
C. difficile infects your small and large intestines after you have taken antibiotics to treat an illness caused by other types of bacteria.
A labeled illustration of the human digestive system, which includes the intestinal tract (labeled in bold), is included below:
Normally, in healthy people, “good” bacteria completely cover the inside walls of their intestinal tracts. The intestinal tract is a series of hollow tubes that food and waste pass through. “Good” bacteria live side-by-side on the inside walls of this hollow tube. In this way, the walls of your intestinal tract act as soil where “good” bacteria attach to create a healthy bacterial “lawn” inside your intestinal tract.
This “lawn” of “good” bacteria facilitates two important processes that occur in your intestinal tract:
• absorption of nutrients from the food you eat
• removal of wastes from your body
To work effectively, “good” bacteria completely cover the total surface area of the inside walls of your intestinal tract. This lush bacterial “lawn” is thick enough to create a physical barrier that prevents “bad” bacteria, such as C. difficile, from living inside your intestinal tract (illustrated below):
Unfortunately, when you get sick with bacterial infections, many of the antibiotics that physicians prescribe for your illnesses cannot target and kill only the “bad” bacteria that have caused your illnesses. These antibiotics will also kill some “good” bacteria in your body, especially in your intestinal tract.
In this way, these antibiotics function like weed killers. When you use weed killers to destroy weeds in your backyard lawn, the weed killers eliminate most of your weeds, but, at the same time, they also kill some of your precious grasses.
By removing some of the “good” bacteria from your intestinal tract, antibiotics create open spaces along the walls of your intestinal tract that C. difficile bacteria can invade.
When C. difficile bacteria attach to the walls of your intestinal tract, they start producing toxins A and B. Your body’s response to these toxins causes the symptoms of a C. difficile infection.
The process that leads to a C. difficile infection is illustrated below:
Usually, very few C. difficile bacteria live in your body. However, if you receive antibiotics during or after a hospital visit, your chance of contracting a C. difficile infection increases tremendously since the microscopic C. difficile bacteria live on hospital walls and equipment.
What are the symptoms of a C. difficile infection?
Symptoms of a C. difficile infection will appear either while taking a prescribed course of antibiotics or shortly after finishing a prescribed course of antibiotics. These symptoms result from your body’s natural reactions to the toxins that C. difficile bacteria release inside your intestinal tract.
Patients with C. difficile infections often experience one or more of the following symptoms:
• diarrhea (most common)
• bloating
• abdominal pain
• gas
• inflammation of the colon (most severe)
How does a physician diagnose and treat a C. difficile infection?
Diagnosis .
• stool sample
• breathe test
These laboratory tests either check for the toxins (A and B) that C. difficile produces or for a chemical that your body produces in response to C. difficile.
Treatment.
Since C. difficile acts like a weed in your intestinal tract’s “lawn” of “good” bacteria, physicians use a process to eliminate C. difficile from your body that is similar to the process you would use to eradicate weeds from your backyard lawn.
To eradicate weeds in your backyard lawn, first you would use weed killers to kill all the weeds that have invaded your backyard lawn. Then, you would reseed your lawn with “good” grasses, like Kentucky bluegrass.
This same approach applies to treating C. difficile: first, use antibiotics to kill all the C. difficile bacteria that have invaded your intestinal tract; then, reestablish the “good” bacteria on the inside walls of your intestinal tract by taking probiotics. Probiotics are capsules filled with “good” intestinal bacteria, such as Lactobacillus.
By killing the C. difficile bacteria that had infected your intestinal tract, antibiotics create empty spaces on the inside walls of your intestinal tract. The “good” bacteria contained in probiotics move into these spaces and reestablish a thick “lawn” of healthy bacteria on the inside walls of your intestinal tract that prevents C. difficile from infecting your body again.
Currently, physicians prescribe two antibiotics, Flagyl or Vancocin, to kill C. difficile bacteria. Probiotics can be purchased at nutrition stores or prescribed by physicians.
Preventing a C. difficile infection
The three best ways to prevent a C. difficile infection are:
• recognize that most people contract C. difficile while in the hospital
• limit prolonged exposure to antibiotics
• avoid antidiarrheal medications when you have diarrhea after taking antibiotics
Second, prolonged exposure to antibiotics, if possible, should be avoided. The longer people are exposed to antibiotics, the more “good” bacteria that the antibiotics will kill in their intestinal tracts. Nonetheless, when patients suffer from severe illnesses or acute infections, their physician’s may feel that taking antibiotics for longer than normal is necessary. In these cases, physicians should be consulted to find out whether avoiding prolonged exposure to antibiotics is appropriate.
Third, over-the-counter antidiarrheal medications should not be used to treat diarrhea while taking antibiotics or immediately after taking antibiotics because antidiarrheal medicines slow down your body’s ability to remove toxins A and B. In this case, diarrhea is your body’s natural response to these toxins because your body wants to eliminate these toxins.
Conclusion: the take-home message
In order to avoid C. difficile infections, patients must closely examine and monitor the antibiotic treatments that they receive. Whenever patients take antibiotics for longer than normal, especially if these antibiotics are taken while hospitalized, patients should discuss with their physicians the possibility of developing a C. difficile infection in order to remind their physicians to consider C. difficile as a potential side effect to taking antibiotics.
However, if a C. difficile infection develops, patients should not lose hope because their infections will heal with time. The healing process will probably take at least six months. Although six months is a long time, current research on C. difficile should lead to the development of more effective methods for treating C. difficile infections.
In my brother’s case, our mom located a physician at Cedars Sinai hospital in Los Angeles who researches C. difficile and who cured Sean’s infection by prescribing some new C. difficile treatments. One of the treatments that this doctor prescribed was a ten-day diet of only Vivonex. Vivonex is a liquid that contains nutrients but lacks sugar, so it killed the sugar-dependent C. difficile bacteria in his body by “starving” them to death. Thankfully, this physician turned out to be a cutting-edge “horticulturist” who knows how to kill weeds and grow thick grass!
Reference
Schroeder, Michael S., M.D., “Clostridium difficile—Associated Diarrhea.” American Family Physician 71.5 (2005): 921-928. 22 April 2005