Metronidazole

Clostridium Difficile

Clostridium Difficile (C. Diff) are known to be anaerobic rod shaped gram positive bacteria which are capable of forming spores. They are known to be the cause of millions of worldwide infections on a yearly basis. They are primarily acquired from hospitals, with incidences of such infections gradually increasing over the last 20 years. They are capable of causing potential life threatening cases of diarrhoea. Although they were discovered in the intestinal flora of new born babies in the 1930s, they were not recognised as a major cause of antibiotic associated diarrhoea up until the 1970s.

Taxonomy

C. Diff belong in the bacteria domain due to their unicellular nature are the peptidoglycan present in their cell walls.

Oral rehydration is generally the preferred method of treatment due to the fact that it allows the hosts response system to deal with the infection and it does not allow for the creation of ecological vacuums where the bacteria might re-emerge. Oral metronidazole or vancomycin are the preferred method of treatment only when symptoms are severe. Metronidazole is more desirable for treatment due the fact that it is less expensive, well tolerated by the body when administered for short periods and does not encourage resistant bacterial development. Intravenously administration of antibiotics has been found to be less effective than the oral administration route. This is due to the fact that intravenous administered antibiotic might not reach the site of infection. In cases where oral administration is not practical, it may be necessary to use a Nasogastric tube or enema administration may be required. The main reasons for the reoccurrence of the C. diff infection following treatment with metronidazole and vancomycin is the fact that neither antibiotic eliminates the C. diff spores. Once antibiotic treatment has concluded, the spores will germinate and the C. diff proliferation will occur, leading to the return of diarrhoea. Also the administration of antibiotics may induce the expression of virulence factors which will be most developed once antibiotic administration has stopped. Thereby diarrhoea reoccurs once the treatment ends. Reoccurrence rates of C.diff diarrhoea varies between 15%-35% and may reach as high as 55% in some cases, with most relapses occurring within the first 2 months. During reoccurrence the original strain may be re-established itself or infection with a different C. diff strain might occur. Symptomatic relapses occur when diarrhoea returns with a positive of the C. diff toxin. If the diarrhoea is mild then a simple