C. diff - for once, a good news antibiotic story

We all worry these days that when we go into hospital we’ll end up sicker than when we started. However, many of my patients, who are terrified of MRSA, have never heard of a much more common infection which is usually caught in hospital or by people who have been taking antibiotics for another reason. In 2008, there were over 40,000 cases of infection with the germ Clostridium difficile - or 'C. diff' - reported through health trusts in the UK. Although C. diff lives harmlessly in the gut of as many as one in 30 adults, taking antibiotics or being ill for other reasons increases the risk of severe diarrhoea when C. diff germs multiply out of control.

Major work has gone on in hospitals up and down the country to reduce rates of all 'hospital-acquired infections', but there are still about 27,000 reported cases, and 3,000 deaths from C. difficile every year in the UK. Compare this to cases of MRSA bloodstream infections reported by hospitals, which have come down from about 4,500 in 2007 to under 2000 a year.

C. diff doesn’t always cause severe illness, but the diarrhoea it gives rise to is at best unpleasant. More worryingly, people who have been infected with C. diff often have spores from the germ still living in their system. This means a lot of them will get further bouts of illness in the future, or can pass the infection on to others. Older people in particular can become very ill with C. diff, and people who develop C. diff in hospital spend an average of 3.6 extra days in hospital.

Improvements in hygiene and cleaning regimes in hospital have had an encouraging impact in reducing the number of people infected. However, we still need effective treatments. Today sees the release of the first new antibiotic to treat C. diff for decades. A new antibiotic is news in itself – they are few and far between these days, with only two new antibiotics being developed worldwide in the last 20 years before this new drug, Dificlir®.

C. diff can be particularly hard to control because of the high number of patients who develop signs of infection again after apparently successful treatment. In trials, Dificlir® proved as effective as, and similarly safe to, the current 'gold standard' treatment, vancomycin. Encouragingly, the number of people who had a recurrence of their illness was more than halved, from 26.9% to 12.6%, among patients taking Dificlir® rather than vancomycin. It could almost be seen as a 'new breed' of antibiotic – unlike many of the antibiotics we use, which kill a broad spectrum of germs and carry a high risk of resistance, this medicine has hardly any activity on other germs and is scarcely absorbed into the system after being swallowed. That means it stays in the gut, targeting C. diff germs and spores. In an ideal world, we’d have eradicated this potentially deadly health hazard. Until then, an effective new treatment is more than welcome.

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