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Staggered, tapered antibiotic withdrawal plus probiotic drink resolved CDI
Among patients with recurrent Clostridium difficile infection, daily consumption of a probiotic drink, coupled with a staggered and tapered antibiotic withdrawal regimen, may be as effective as fecal microbiota transplant at resolving the infection, according to a brief report published in Clinical Infectious Diseases.
“Fecal microbiota transplant (FMT) has been very effective, even more effective than any other recommended or published treatment,” Johan S. Bakken, MD, PhD, of St. Luke’s Hospital in Duluth, Minn., told Infectious Disease News. “However, some patients are adverse to FMT, or they are unable to find a donor or are unable to afford the cost of screening a potential donor or use a commercial stool bank. This is an alternative that may work just as well as fecal transplant.”
Johan S. Bakken
In the staggered and tapered antibiotic withdrawal (STAW) regimen, patients receive antibiotic therapy with metronidazole or vancomycin, combined with the probiotic drink Kefir (Lifeway Foods), until normal bowel movements are established and maintained for about 1 week. They continue the antibiotics for a 6-week period, taking doses in 72-hour intervals, with gradual dose reductions each week. The patients also continue to drink Kefir for at least 2 more months after completing antibiotic therapy.
“With a STAW regimen, the idea is that if the colon has an antibiotic-free period with intermittent antibiotic dosing, the inactive spores become vegetative and susceptible to antibiotics, and are killed with the next dose,” Bakken said. “At the same time, you provide a continued supply of probiotics to compete with the C. difficile and augment the immune response against it.”
This prospective study included 25 patients with recurrent CDI who were treated with STAW from 2009 to Oct. 31, 2013. The patients drank 5 oz of Kefir at least three times a day. All patients had re-established normal bowel function at the start and completion of STAW, and 21 patients were diarrhea-free for 9 months following. Twenty patients are diarrhea-free for more than 12 months. Among the four patients who relapsed, their diarrhea was resolved after a 2-week course of vancomycin followed by a 2-week course of rifaximin (Xifaxan, Salix Pharmaceuticals).
“Antibiotics can easily curtail an active infection, but can’t eliminate the spore population in the colon,” Bakken said. “At the same time, antibiotic treatment with vancomycin or metronidazole will decimate the friendly bacteria in the colon, resulting in a very dysbiotic colon environment with a large population of spores. This is why patients have many recurrences after treatment.”
Bakken said that he and his colleagues are in the process of designing a prospective study in their hospitals in which patients who are starting antibiotic therapy in house are also given Kefir three times a day until they complete their antibiotic course or are discharged. The objective will be to see if it can reduce the frequency of hospital-acquired CDI. — by Emily Shafer
Disclosure: Bakken reports no relevant financial disclosures.