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C. Diff diarrhea is every patient’s worst nightmare. C. diff is a bacterium that normally occurs in the bowel in very tiny portions. When you are placed on certain antibiotics, and the natural bacteria are killed off, the C. diff bacterium can grow into a much larger contributor. This causes a disease called pseudo-membranous colitis. The bowel will weep huge amounts of fluid and you may end up having 8 to 12 bowel movements a day, which are very liquid. Patients who have had C. diff know that it has a particular odor to it and if they call your office and say that they feel they have C. diff, based on the odor of the stool, you must listen to them. Have visiting nurses get a sample but start treatment immediately. This is an urgent situation, because they quickly can become dehydrated and very ill.
You should consider Vancomycin 500 mg TID to QID until the diarrhea starts to ease and decrease to 250 mg TID times 10 days. Patients should also be placed on Florastor, as a probiotic, while on treatment and of course – stop the antibiotic.
You need to really understand what a medical and social emergency this is. Ambulatory people often will use a pad or diaper, because of the bowel urgency. Can you only imagine the additional factors of doing a transfer onto a commode, clothing manipulation and likely cleanup of the patient and surroundings in a weakened state. The medicine orders can’t wait until the end of day, they need to be done immediately. You should probably have them delivered, to avoid delay.
If the patient reports any blood in the stool or doesn’t respond quickly, I have used Mesalamine 400 mg TID to treat the actual disease, which is pseudomembranous colitis. Remember, C. diff is only the bacterium. Mesalamine is an anti-inflammatory for bowel inflammation and can facilitate a tremendous improvement in the sickest of patients. In 33 years, I never had to send patients to the hospital, acutely ill, because of their C. diff infection.
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