We've had previous warning posts about the worrying risk of severe side effects from Fluoroquinolone Antibiotics as well as posts about how difficult it is to eradicate a Clostridium difficile infection. So I was interested to read of the tie between the two!
Restricting the use of fluoroquinolone antibiotics was more effective than measures such as "deep cleans" of hospitals in reducing the incidence of Clostridium difficile (C. diff) in Oxfordshire and Leeds, England, researchers reported.
:
Derrick Crook, MBBCh, of the University of Oxford, and colleagues explained that the study "shows that the C. difficile epidemic was an unintended consequence of intensive use of an antibiotic class, fluoroquinolones, and control was achieved by specifically reducing use of this antibiotic class, because only the C. difficile bugs that were resistant to fluoroquinolones went away."
Thanks for this post, Neil. What an interesting and important find.
I was reading yesterday about the hazards of infection when hospitalized and I know there are people on this site who have had the experience of hospitalization-related infections.
We may need to wear medical bracelets that say NO CIPRO or related antibiotics.
From personal experience, I think we need to question our doctor if we are prescribed Cipro antibiotics to see if something else could be tried first. Just use them as a last resort (which also means they'll remain more effective due to less opportunities for bacteria to develop resistance). I refused them when they were recommended in addition to IV antibiotics to combat cellulitis. A few weeks after being discharged from hospital, the cellulitis flared up, more dangerous and far more painful than before. One course of Cipro resolved the cellulitis and while my CLL specialist was concerned it could return, it hasn't done so in nearly 3 years now!
Yes, that makes sense. Last February, I was given a ( Zithromycin Zip pack) for whatever I had--the hemo/onco I was seeing and called to ask to be seen because of hoarseness AND the yellow mucus meant infection, orded the Zithromycin. After 10 days, I was no better so I called again, and the prescript called in was for Cipro (I had never heard of it.) It worked but pretty slowly.
Is there anything in between those two antibiotics that could be tried before Cipro? I don't know. I do know, no one saw me and no one ever asked me about it at any subsequent appt.
Serious lack of follow-up with antibiotics in my case, I think--and probably not unusual across the board.
Neil an interesting paper, I am pleased to read that the withdrawing of intensive and improper prescribing of this class of drug seems to have ensured it's efficacy for when we need it. As they studied 4000 C Dif bugs I wonder if they can facilitate encouragement of similar practices in reducing overuse of others to prevent misuse in the general population of other classes of antibiotics.
In this age of a need for proper antimicrobial stewardship, we need to find strategies and proof of their efficacy to enable us to hang on to and protect the effective antibiotics we have for when they are needed or we will return to the dark ages.
Now standing naked without any white blood cell defenses i feel more vulnerable than i can ever remember, and like many fear admission to hospital especially at this time of year how hard it is to make that necessary call when your temperature spikes when neutropenic!
Last year I took part in a Wales NHS initiative as a public and patient interest group (PAPIG) steering group member during the set up of an antimicrobial stewardship citizens jury initiative to address how patients and the public can help healthcare professionals reduce
Interesting paper Neil (I'm sure I can hear Sparkler cheering that the message is getting out there about this class of antibiotics).
I have 'Absolutely no Fluoroquinolones' written into the Care Plan my GP holds for me and I always tell hospitals I'm allergic to them. It's the only way they'll listen and will protect me from being given them if I'm not in a position to object.
If they absolutely had to be used as a last resort, I'd have to have the conversation but at the moment I won't take the risk they represent.
Thanks Neil- I forwarded this to a friend who had a bout of C-Dif. She said it was the worst thing she'd ever been through (and she had heavy duty chemo for breast cancer in the past)
Neil, Just the other day Pfizer announced that they had good results from a Phase 2 Study testing a vaccine for C.difficile. They were going to start a Phase 3 Study. The FDA had given the vaccine Fast Track designation. I have copied below part of their press release:
Pfizer’s C. difficile Vaccine Candidate to Commence Phase 3 Study in First Half of 2017
C. difficile is an Increasing Worldwide Concern Associated with Approximately 29,000 Annual Deaths in the U.S. Alone
Thursday, January 26, 2017 - 8:00am
Pfizer Inc. (NYSE:PFE) announced today that the Phase 2 study evaluating the Company’s Clostridium difficile (C. difficile) vaccine candidate, PF-06425090, provided positive data, based on a pre-planned interim analysis. The randomized Phase 2 study (NCT02561195) examined the safety, tolerability, and immunogenicity of the vaccine in healthy adults 65 to 85 years of age. Pfizer’s vaccine candidate is designed to help prevent C. difficile infection (CDI), which can include life-threatening diarrhea and pseudomembranous colitis,1 by inducing a functional antibody response capable of neutralizing the two main disease-causing toxins produced by C. difficile (toxins A and B).2
“Despite improved infection control measures, C. difficile disease continues to rise, further augmenting an already urgent public health threat with particular negative impact on older adults,” said Kathrin Jansen, Ph.D., senior vice president and head of Vaccine Research and Development for Pfizer Inc. “We are very encouraged by these interim immunogenicity and safety results demonstrating robust increases in vaccine-elicited neutralizing antibodies to both toxins, that we believe could provide protection against C. difficile disease.”
Based on findings from the pre-planned interim analysis, Pfizer’s C. difficile vaccine candidate will progress into Phase 3 in the first half of 2017. Pfizer’s C. difficile vaccine candidate was granted Fast Track designation by the U.S. Food and Drug Administration (FDA) in August 2014. The FDA’s Fast Track designation is designed to facilitate the development and expedite the review of new drugs and vaccines intended to treat or prevent serious conditions and address an unmet medical need.3 About the Phase 2 Study The Phase 2 study (NCT02561195) was a randomized, placebo-controlled, observer-blinded study of more than 850 healthy adults 65-85 years of age, evaluating the safety, tolerability, and immunogenicity of two dose levels (100 µg and 200 µg) of Pfizer’s C. difficile vaccine candidate on two different three-dose vaccination schedules (Days 1/8/30 and Months 0/1/6). More information about the PF-06425090 Phase 2 study can be found at clinicaltrials.gov (link is external).
I didn't get any notice of this post, or the tag, or I'd have responded sooner Neil.
I wish I could say otherwise but unfortunately, the message isn't getting through and Quinolones (Cipro's the most popular choice, though others are used often) are still being dished out innappropriately; not being used as a 2nd or 3rd line defence but as 1st line (which for certain conditions has to be the chosen antibiotic) for simple, uncomplicated infections. This happens in hospitals and GPs are still prescribing, all yet to understand or believe the damage they cause, in part because they don't recognise the ADRs can be delayed by months or longer. They also fail to understand that ADRs occur in clusters of symptoms, as the effects of Quins are like a chain reaction as Mitochondria and Collagen etc., are destroyed.
I'm in contact with some very sick and disabled people due to Quins, including a 4 year old child and and we are busy 'fighting' the MHRA, and NICE (we have a Stakeholder in NICE and an Antimicrobial Steward) to actually do something about this horrendous situation, as millions of people are suffering; mortalities too. The ignorance amongst the medical profession is astounding. Big Pharma has long arms with a big reach though... it also means that many people who're severely affected, can't access help from the medical profession, because they're not being believed - told they're imagining it all, or misdiagnosing them with ME/CFS or Fibromyalgia and even Parkinson's or Motorneurone disease. They are in pain; lose their jobs; relationships break down and nobody helps them. Some doctors are aware but they are very few and far between.
Canada has just reinforced its warnings on Cipro but labelling doesn't go nearly far enough...nobody reads them!
The link between use of Quins and increase in C.diff have been known about for many years; Quins damage the gastro-intestinal system and like other antibiotics (though more so because of their broad spectrum quality and strength) destroy natural, good gut flora and lower immunity. It's ironic that despite this knowledge and supposed restriction of Quins, there are still new Quins in the pipeline; being fast-tracked in the U.S. One (Delafloxacin) is 32 x stronger than Cipro. I'll find a recent paper about this and the Canada warnings and post the links when I find them.
I find it interesting reading about various Adverse Reactions to Ibrutinib, that some CLLers are experiencing, as they are extremely similar to some ADRs due to Quins.
Please, please don't take (Fluoro)Quinolones unless you have no choice.
I tried to notify you in my post, but there was a bug in the notification system so your username wouldn't come up. Thanks for your updates. Hope you are over your tendon rupture, etc. You've had a tough time with that...
It's ok Neil. I can see my username's blue now and to be fair, your post may have been in my Daily Digest but I'm spinning plates and that day I might not have looked properly through the whole list, as I never would not notice the word Fluoroquinolone 😉
My ADRs...thanks for mentioning them...all I can say is that nearly 4 years later, I'm much better than I was but not free of them yet. Some things improve, whilst others worsen and new ones appear. There's no comparison now though, to how I was when the Levofloxacin bomb first exploded in me.
Quick question...has anyone posted about 'Spider Silk'? If not, then I will...
Floxie Hope is a very good source of information about Quins; articles and 'recovery' stories but I do not recommend the patient forum, as it's a mix of some good info, hidden amongst a lot of rubbish. There is no cure for Quinolone Toxicity Syndrome yet but understandably, people seek the quick fix. I'm not a member of the forum but pop in occasionally just to look.
NEW YORK Asymptomatic carriers of Clostridium difficile may contribute to the spread of the infection in hospitals, according to new research.
"In a situation where nosocomial C. difficile infection is a significant problem despite e.g. isolation precautions and antibiotic stewardship one should consider to test the patients admitted for being asymptomatic carriers. If the load is high then one should consider isolation precautions among the carriers," Dr. Thomas Blixt of the University of Copenhagen, Denmark, one of the study's authors, told Reuters Health by email. The findings were published online January 5 in Gastroenterology.
In a population-based prospective cohort study in Denmark, we found that asymptomatic carriers of toxigenic C difficile in hospitals increase risk of infection in other patients.
Thank you Neal for this post! It saved me from getting Cipro in the hospital this week. My GI wanted to put me on it for surgery and afterwards and I told him I wanted something different due to the many horrible side effects over and above the C-diff issues. He rolled his eyes but told me they could probably use Recephin. When they came in that afternoon to give me my first dose, it was Cipro. I told them what my GI doctor had said, but the hospital doctor was adamant about using the Cipro. My GI doctor was not available at that time to approve the Recephin. Fortunately for me, I had a caring nurse in the room, who had first hand knowledge of people in wheel chairs for the rest of their lives due to use of Cipro. He spent a good two hours off and on between the hospital doctor, the hospital pharmacist and my GI's office to get them to switch drugs. It should not be this hard, but it does show how important it is to stay up on the medical info that can help us. As the CLL Society says, "Smart Patients Get Smart Care".
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