The Search for a Better Treatment for Recurrent Clostridium difficile Disease: Use of High-Dose Vancomycin Combined with Saccharomyces boulardii

Recurrent Clostridium difficile disease (CDD) is a difficult clinical problem because antibiotic therapy often does not prevent further recurrences. In a previous study, the biotherapeutic agent Saccharomyces boulardii was used in combination with standard antibiotics and was found to be effective i...

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Bibliographic Details
Published in:	Clinical infectious diseases Vol. 31; no. 4; pp. 1012 - 1017
Main Authors:	Surawicz, Christina M., McFarland, Lynne V., Greenberg, Richard N., Rubin, Moshe, Fekety, Robert, Mulligan, Maury E., Garcia, Reuben J., Brandmarker, Sally, Bowen, Karen, Borjal, Delia, Elmer, Gary W.
Format:	Journal Article
Language:	English
Published:	Chicago, IL The University of Chicago Press 01-10-2000 University of Chicago Press
Subjects:	Aged Anti-Bacterial Agents - administration & dosage Antibiotics Bacterial diseases Bacterial diseases of the digestive system and abdomen Biological and medical sciences Clostridium difficile Clostridium difficile - drug effects Clostridium difficile - isolation & purification Colitis Combined Modality Therapy Diarrhea Dosage Double-Blind Method Enterocolitis, Pseudomembranous - drug therapy Enterocolitis, Pseudomembranous - microbiology Enterocolitis, Pseudomembranous - therapy Epidemiology Feces - microbiology Female Human bacterial diseases Humans Infectious diseases Major Articles Male Medical sciences Middle Aged Placebos Probiotics - therapeutic use Recurrence Relapse Saccharomyces Toxins Vancomycin - administration & dosage Short term Recurrence Peptides Clostridiales Saccharomyces Vancomycin Fungi Prevention Etiology Glycopeptide Bacteria Intestinal disease Ascomycetes High dose Thallophyta Human Drug combination Clostridium difficile Diarrhea Infection Antibiotic Chemotherapy Treatment Clostridiaceae Bacteriosis Digestive diseases Antibacterial agent
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Summary:	Recurrent Clostridium difficile disease (CDD) is a difficult clinical problem because antibiotic therapy often does not prevent further recurrences. In a previous study, the biotherapeutic agent Saccharomyces boulardii was used in combination with standard antibiotics and was found to be effective in reducing subsequent recurrences of CDD. In an effort to further refine a standard regimen, we tested patients receiving a regimen of a standard antibiotic for 10 days and then added either S. boulardii (1 g/day for 28 days) or placebo. A significant decrease in recurrences was observed only in patients treated with high-dose vancomycin (2 g/day) and S. boulardii (16.7%), compared with those who received high-dose vancomycin and placebo (50%; P = .05). No serious adverse reactions were observed in these patients. Comparison of data from this trial with data from previous studies indicates that recurrent CDD may respond to a short course of high-dose vancomycin or to longer courses of low-dose vancomycin when either is combined with S. boulardii.
Bibliography:	ark:/67375/HXZ-BLWKPV1C-9 istex:D97A9AFD69B0A244812DBE572E8786126D9FBA91 Grant support: Support was received from a grant (PMC Relapse) from Laboratoires Biocodex (Montrouge, France). ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1058-4838 1537-6591
DOI:	10.1086/318130