C. Difficile Diarrhea: Prevention & Treatment

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C. Difficile diarrhea in Lyme disease image by Marty Ross MD

Clostridium Difficile (C. diff) in Lyme Disease Diarrhea

Clostridium difficile (C. diff) overgrowth in the intestines causes diarrhea. This is a bacterium, which lives in our intestines and can grow too much when a person is on prescription antibiotics. Here are the steps to treat and prevent this condition.

C. diff normally lives in the intestines in balance with the other intestinal organisms. However, some antibiotics result in the germ becoming excessive. In excess it releases a toxin that leads to severe diarrhea and abdominal cramping. There is a stool test for the toxin to determine if a person has this infection. 

When C. diff is present, stop Lyme antimicrobials and start one for C. diff. Saccharomyces boulardii (Sacro B) is a beneficial yeast that lives in the intestines that can help treat and prevent C. diff. When antibiotics fail an alternative treatment for C. diff uses transplants of stool from healthy donors called a fecal microbiota transplant. More recently, for those with recurrent C. diff diarrhea, bezlotoxumab infusion (a monoclonal antibody against the C. difficile toxin) is recommended as an addition to using antibiotics. 

C. Difficile Prevention in Lyme Disease

You can help prevent C. diff by taking probiotics. This is very important in someone who has a history of C. diff diarrhea. In this type of situation, Sacro B is very effective at preventing another episode of C. diff.

  • Probiotics. Start at 2 pills 1 time a day. In my practice I recommend Multi-Biome by Researched Nutritionals which contains human and soil-based strains. When diarrhea is present, double the dose to 2 pills 2 times a day. Be sure to take it as far away from antibiotics as possible.
  • Saccharomyces boulardii (Sacro B). Start at 4 pills 1 time a day for active diarrhea. Once you have had a C. diff infection, you should remain on this at 4 pills 1 time a day while you are on herbal or prescription antibiotics for Lyme to prevent C. diff from causing diarrhea again.

C. Difficile Treatment in Lyme Disease

When diarrhea occurs due to C. diff, herbal and prescription antibiotics for Lyme and the co-infections must be stopped. There are three antibiotics that treat this condition. Use vancomycin or fidaxomicin first. If they do not work, then consider metronidazole. While metronidazole is much cheaper than the other antibiotics, it is much less effective and has more potential for side effects. In addition, use an effective probiotic and Sacro B.

Antibiotics

  • Vancomycin 125 mg 1 pill 4 times a day for 10 days
  • Fidaxomicin 200 mg 1 pill 1 time a day for 10 days
  • Metronidazole 500 mg 1 pill 3 times a day for 10 days

Probiotics

  • Probiotics. Start at 2 pills 1 time a day. In my practice I recommend Multi-Biome by Researched Nutritionals which contains human and soil-based strains. When diarrhea is present, double the dose to 2 pills 2 times a day. Be sure to take it as far away from antibiotics as possible.
  • Saccharomyces boulardii (Sacro B). Start at 4 pills 1 time a day for active diarrhea. Once you have had a C. diff infection, you should remain on this at 4 pills 1 time a day while you are on herbal or prescription antibiotics for Lyme to prevent C. diff from causing diarrhea again.

Fecal Microbiota Transplant

This is a very effective way to treat C. diff if one or two rounds of antibiotics do not work. Studies show it works about 90 percent of the time. It can be administered in a physician's office or the home by enema. Another option is to take 30-40 freeze dried pills a day for about 10 days.

Bezlotoxumab

If there is a recurrence of C. diff after initial antibiotics, then adding Bezlotoxumab to the next antibiotic treatment may help to prevent further relapses. Bezlotoxumab is a monoclonal antibody against the C. difficile toxin.

  • Belotoxumab 10mg/kg/dose 1 time.

Disclaimer

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References

View Citations

  1. Fitzpatrick LR. Probiotics for the treatment of Clostridium difficile associated disease. World J Gastrointest Pathophysiol. 2013;4(3):47-52. doi:10.4291/wjgp.v4.i3.47. (View)
  2. McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1–e48. doi:10.1093/cid/cix1085. (View)
  3. Oksi J, Anttila VJ, Mattila E. Treatment of Clostridioides (Clostridium) difficile infection. Ann Med. 2020;52(1-2):12-20. doi:10.1080/07853890.2019.1701703 (View)
  4. Quraishi MN, Widlak M, Bhala N, et al. Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection. Aliment Pharmacol Ther. 2017;46:479-9 doi:10.1111/apt.14201. (View)
  5. Saha S, Khanna S. Microbiota replacement for Clostridium difficile by capsule is as effective as via colonoscopy. J Thorac Dis. 2018;10(Suppl 9):S1081-S1083. doi:10.21037/jtd.2018.04.18. (View)
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About the Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice. 

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS) and The Institute for Functional Medicine.

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