A good and relevant article
Dr. Simcha Shapiro
Daily Kefir With Tapered Antibiotics May Help Resolve Recurrent C difficile Infection
By Lorraine L. Janeczko
June 26, 2014NEW YORK (Reuters Health) - The fermented drink kefir taken with a staggered and tapered antibiotic withdrawal regimen may help resolve recurrent Clostridium difficile infection (CDI), a new case series suggests.
Between 5% and 30% of patients with CDI fail treatment with metronidazole or vancomycin, Dr. Johan S. Bakken, from St. Luke's Hospital and the University of Minnesota Medical School Duluth, notes online June 9 in Clinical Infectious Diseases.
Although fecal microbiota transplantation (FMT) has been the most successful treatment option for these patients, it may be unattainable for those who need it most, he writes.
Kefir is a fermented dairy product that contains probiotic agents. To investigate whether kefir (Lifeway Kefir, Lifeway Foods, Inc) would help resolve recurrent CDI when combined with staggered and tapered antibiotic withdrawal (STAW), Dr. Bakken studied 25 patients, including 21 women and four men. All had opted not to be treated with FMT when given the choice. Patients had a mean age of 68 years and were initially hospitalized or being treated in outpatient clinics.
Prior to the study, referring physicians had started the patients on metronidazole, vancomycin, fidaxomicin, or nitazoxanide.
For STAW, patients were given metronidazole or vancomycin. STAW was started once the patients had normal formed bowel movements for at least seven days. Each antibiotic dose was taken every 72 hours for six weeks, with the dose gradually reduced every two weeks.
Patients were instructed to drink at least three glasses of kefir per day, as a 5-ounce glass with each meal or freely as tolerated.
Participants had had a mean of four CDI relapses prior to the study and a median of 135 days of diarrhea from their initial diagnosis to the beginning of STAW. Over the same period, the 25 patients submitted a combined total of 103 stool samples for C. difficile testing and had an average of 3.6 positive samples each.
All 25 patients had re-established normal bowel function with formed bowel movements at the beginning and end of STAW. Twenty-one (84%) remained diarrhea-free during the following nine months, and 20 remained symptom-free for longer than 12 months. Four patients (16%) had diarrhea relapse with stool positive for C. difficile between 24 and 45 days after they completed STAW.
The four patients who relapsed resolved their diarrhea permanently after a two-week course of oral vancomycin followed by a two-week course of rifaximin. They remained symptom-free after 12 months of follow-up.
As to whether this strategy is worth trying in the absence of larger trials, Dr. Bakken told Reuters Health, "Absolutely. This is a down-to-earth, simple treatment approach that exploits a potential weakness on the C. diff organism and you have little to lose to try it as an alternative to FMT. It's easy to do, and most patients who have failed standard vancomycin dosing would end up spending less because they would need fewer vancomycin capsules."
Dr. Mark H. Wilcox, a microbiologist at the University of Leeds and clinical director of microbiology at Leeds Teaching Hospitals NHS Trust in the UK, cautioned in an email to Reuters Health, "It is always difficult to interpret efficacy data from uncontrolled case series that often comprise very different individuals. For instance, in this study some patients had only one prior recurrence of CDI while others had had nine episodes."
"The diagnosis of CDI was also not consistent," Dr. Wilcox added. "Importantly, given the study design, we do not know the influence of the prolonged antibiotics versus the probiotic product. Overall, the results are promising, but further study is needed before this treatment option can be recommended."
Dr. Bakken acknowledged that limitations to his study include the small number of patients, the retrospective nature of the analysis, and an uncontrolled study population treated by a single provider.
Dr. Wilcox, who was not involved in the study, advised, "We know that several different alternatives are available to treat patients with recurrent CDI. What we need to know is which ones are the best and most cost-effective therapies. Carefully designed studies are needed to determine these answers."
Dr. Bakken agreed, saying, "I absolutely believe that larger trials should be performed, but in the absence of larger trials, this pilot study gives us encouraging information. It's up to the individual who has recurrent C. diff episodes who doesn't seem able to break the cycle to decide whether or not to try this treatment."
Dr. Bakken and Dr. Wilcox reported no conflicts of interest related to study.
SOURCE: http://bit.ly/1v6Ahme
Clin Infect Dis 2014.
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