Stephen King comes to mind when I think of Clostridium difficile.

Named “difficult” because it is challenging to isolate and grow in the laboratory. In the normal person, this bug is often living without incident among the trillion other microbes that reside in the large intestine (Colon). These microbes play a vital role in our Health. Antibiotics, especially the broad spectrum types, are a game-changer. Killing good and bad bugs indiscriminately, it creates a state of Anarchy allowing this Intestinal Taliban to take over.

Not surprising, this bacteriahas always been a nasty player in hospitals. Sick patients usually get antibiotics, often multiple ones. These efficiently wipe out the gut flora, allowing the bad guys to take over.This bacteria act by producing toxins that affect Intestinal functions: secretion, ability to absorb and contract.

The immune system, our body’s Homeland Security, is unable to defend effectively. In the ensuing fight, the colon gets inflamed, watery diarrhea depletes the body of water, electrolytes and nutrients. The patient feels pain, cramps, weak and wasted. Unchecked, the colon wall gets thickened, is unable to contract effectively, and can balloon up and sometimes burst.

What is the treatment? More antibiotics to kill Mr. Difficult, and “nation building”: restore civic order to rehabilitate the trillion microbes back in their home in the colon. Neither task is easy to accomplish.

When exposed to an effective medicine, this bacteria responds by developing Spores, that allows it to hide in a protective shell. A few days later when the medicine has passed, Clostridium difficile takes over the colon all over again.

Probiotics, supplement that contain live microbes, help to restore the normal gut flora. Acidophilus, Lactobacillus, Saccharomyces are common names that are often sold in the market, as components of foods like yogurt, and in health food stores. Some work better than others, and while a capsule of this supplement often contains 10 billion or so microbes, it still remains a challenge to rebuild the trillion-strong community back in the colon. In desperation, researchers have even tried fecal therapy: using the stool of healthy donors.

Its current activities now suggest it has progressed from street punk to Mafia. The Center for Disease Control reports a new strain in the US that is producing more toxins, is resistant to antibiotics, causing more disease and death, especially among the elderly. More patients are acquiring it outside the hospital setting. This bacteria has mutated to cause more relapses and recurrences.

In my practice, I have seen some patients develop up to five relapses, even after getting the correct treatments. Some recurrences happen a year after the initial attack. Not surprising, hospitals and nursing homes are often playing a game of Ping-Pong with a patient getting treated, returning within a few weeks now with another raging attack.

When I see a patient with this problem, my first advice is to stop any unnecessary antibiotics. If the patient has had relapses, I will prescribe antibiotics along with Probiotics, to be taken over a period of months. After the first 2 weeks, I will decrease the frequency of the antibiotics progressively, so finally they are taking the drug every 3 days. This allows the spores to germinate, the bacteria to re-emerge and then the medicine to again kill it off. Pulse dose treatment gives time for the flora in the colon to rebuild to healthy levels.

Rapid testing is now available in most laboratories that can give a result often within an hour. Newer drugs are being developed to kill this pathogen. Infection control measures in hospitals and nursing homes help to quarantine affected patients, and to continue these measures for a few days after the patients’ test negative.

As a Community how do we fight this? Hand to hand combat? Yes! Wash hands vigorously with good old soap and water. Avoid the expensive stuff that says it has “anti-bacterial” additives. They are part of the problem. Convenient alcohol based rubs don’t work for this bug.

Next time you have the sniffles, let the viral infection run its course. It will take seven days or so. If you pester your doctor and wrangle out a prescription of antibiotics, recovery will take a week. No gain, but you may end up killing the resident citizens in your Colon, perhaps inviting trouble. We need to restrict the use of indiscriminant antibiotics for live-stock. Bacteria mutate. The more prevalent is our use of antibiotics, the greater the chance drug-resistant strains will evolve.

What comes around goes around. It’s worse when it sticks around in your gut!