Via practica 4/2011

Diarrhea caused by Clostridium difficile and use of probiotics

Diarrhea caused by Clostridium difficile toxin has to be taken very seriously especially in elderly and polymorbide patients because of the severe after effects of dehydratation and metabolic disruption. The terapy of clostridium enterocolitis (CE) is complicated by development of the first line treatment resistance. Deficiently treated patients can become asymptomatic carriers of CD in nursing homes or at home. Prevention of the the CE origination, its relapses and moderation of clinical symptoms shortens the lenght of hospitalization and reduces costs. We have analysed the incidence of CE on the Department of long term ill within 13 months (9/2008 – 9/2009). For every patient with diarrhea we have tested the stool samples for the presence of CD toxines. From 275 patients (mostly imobile), by 28 (10,08 %) the diagnosis CE was confirmed during the hospitalization. Bronchopneumonia and urinary tract infections were the most often reasons for antibiotic terapy. Ciprofloxacin was the most used first line antibiotic in patients with later determined CE. In our group the combinated antibiotic terapy seems to be a risk factor for resistance to standard metronidazol therapy of CE. According to our experience the use of probiotics can reduce the occurence of diarrhea during antibiotic therapy. Even more extensive studies specialized on probiotics are expected in the future. We would like to point out the importance of rational antibiotic prescription and use.

Keywords: Clostridium difficile, enterocolitis, postantibiotic diarrhea, probiotics