Clostridium difficile-infections, or CDI, also known as Clostridium difficile-associated Diarrhea, or CDAD, is an antibiotic-resistant, gastrointestinal bacterial infection afflicting more than 500,000 people annually with rates significantly rising since 2000.

How is it contracted?

The infection is commonly contracted by hospitalized patients who are taking antibiotics, often the elderly. C. difficile bacteria are found in feces, which can contaminate surfaces and spread by healthcare workers through hand contact. A 2010 British study showed that clostridium difficile also travels through the air, which contributes to the overall spread of the bacteria. CDI cannot be contracted through inhalation.

What can be done?

When undergoing hospital care of any kind, be sure to discuss prudent antibiotic use and thorough sanitation procedures (e.g. washing hands with warm water and soap before and after dealing with a patient, since alcohol-based hand sanitizers may not effectively destroy C. difficile spores) with a doctor in order to help minimize the risk of acquiring CDI. It is important to be aware of the signs and symptoms of CDI, as well as the treatments available to address the disease.

Can relapse episodes occur even if the original infection was treated?

Yes. Such multiple episodes are seen in about 20% of persons who develop the original infection. Most cases resolve after 1-2 relapses but a few go on to multiple relapses. There is no known cure although several methods are used to try to get the relapses under control. The most frequently used method employs a prolonged course of vancomycin followed by a tapering schedule. One should always consult with a physician who is experienced in dealing with multiple relapses to identify the appropriate care.

Are fecal transplants the best treatment for someone who has taken Flagyl and Vancomycin?

Clostridium difficile infections are difficult to treat especially in elderly patients and patients with underlying conditions. Fecal bacteriotherapy is considered a good option and several scientific articles have reported good results but even if you have tried it before, the standard CDI treatments (vancomycin and metronidazole) remain good options and can still be effective.

I've had diarrhea for over a month. At first, I thought it was my diet, but my diarrhea kept getting worse. My doctor did a fecal test, found Clostridium difficile, and prescribed a generic of the antibiotic Flagyl. I've taken Flagyl for 13 days, but still have watery diarrhea. What should I do?

Tell your doctor about your symptoms today. Your symptoms may be the normal course of the disease as the bowel heals slowly. However, this could potentially be a treatment failure, a relapse of CDI, or something else altogether. Your doctor may want to discuss your treatment options with an infectious disease specialist or gastroenterologist. If your doctor is not available, you may want to visit a nearby emergency room.

Flagyl is one of two antibiotics commonly prescribed for Clostridium difficile infections, but sometimes it does not work. The only FDA-approved antibiotic for Clostridium difficile infections is vancomycin.

My doctor found clostridium difficile in a fecal test. I was not previously taking antibiotics, nor was I in a hospital or nursing home. Where did I get CDI? Is there anything I can ask my doctor that may help me?

People in good health usually don’t get C. difficile infection. People who have other illnesses or conditions requiring prolonged use of antibiotics and the elderly are at greater risk of acquiring this disease. The bacteria are found in the feces. People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to other patients or contaminate surfaces through hand contact.

Your doctor is the best person to go to and ask for advice. He/She could ask more details about CDI treatments to an infectious disease specialist or a gastroenterologist, and they may discuss together what the best treatment for your case is with all the symptoms you have.

Do specially treated hospital cubical curtains effectively eliminate CDI?

Fabrics, toys, dishes, etc., impregnated with antibacterial substances are highly popular now. Several authors, including Dr. Stuart Levy, professor of Medicine at Tufts University School of Medicine, have commented that such an approach will not work and it will not stop spread of any infectious agents.

My Mom returned home after a three week bout with CDI & was clean from infection, however after a 10 day stay at home it has returned. She is 94 years old and losing weight every day. How should we support this conditition at home and should we be giving her probiotics?

We are sorry to hear about your mom's illness with CDI. While probiotics are widely used to treat C. difficile infection, the experts doubt that such remedies have any useful place in the therapy. Please continue to seek the advice of a physician for her condition.

Is Fidaxomicin currently available in U.S.? I have an elderly mother with recurrent c. diff, currently tapering on vanc.

Unfortunately, fidaxomicin has not been reviewed by the FDA yet and therefore is not available for the treatment of CDI: all the clinical trials have been completed and Optimer Pharmaceuticals is currently preparing the dossier to file for approval to the FDA in 2010. Wishing we could do more for your family and wishing the best to your mother.

I am having diarrhea on & off for several days especially after eating veggies, salads and fruits.

The uncomfortable symptoms you are mentioning do not point clearly towards CDI (please refer to the Understanding page on the www.cdiinfo.org website for a detailed description of CDI); they are not specific enough to determine the cause of your diarrhea: you should seek the advice of your physician to understand your condition better and help you address it.

How long are you contagious with C-Diff after being treated with antibotics?

It is very difficult to determine the level of contagiosity of a patient infected with Clostridium difficile. The potential for spreading the germs depends on the number of organisms remaining in the gut and shed in the environment. C diff is a spore-forming bacterium that can survive on surfaces in that form very long, and is very resistant to standard cleaning and disinfecting procedures. Even though antibiotic treatment usually treats the symptoms and kills most of the germs in the colon, some may remain in a spore form and reappear after treatment or just survive in the patient’s environment for some time after the patient feels cured. Since the detailed answer to that question depends heavily on the diagnosis, the intensity of the disease, and the treatment characteristics the patient has received, and the environment he/she is living in, we recommend you seek the advice of your physician and healthcare facility to understand better your personal situation and receive advice customized to your situation.

CDC, Severe Clostridium difficile—Associated Disease in Populations Previously at Low Risk --- Four States, 2005. 2 Dec. 2005. 5 Feb. 2008

Kuipers, Ernst J., and Christina M. Surawicz. “Clostridium difficile infection.” The Lancet 37 (2008): 1486-1488.

L. Clifford McDonald, Maria Owings, and Daniel B. Jernigan; “C. difficile Infection in Patients Discharged from US Short-stay Hospitals, 1996-2003.” Emerging Infectious Diseases. 12(3) March 2006: 409-15.

Mayo Clinic. C. difficile. 13 Dec. 2006. 5 Feb. 2008

Clostridium difficile-Associated Diarrhea Evolving Trends in C. difficile Associated Disease (CDAD), A Report from the 17th ECCMID/ 25th ICC. 17TH European Congress of Clinical Microbiology and Infectious Disease and 25th International Congress of Chemotheraphy Conference. March 2007. Munich, Germany.

Monaghan, Tanya, and Timothy Boswell, and Yashwant R Mahida. "Recent advance in Clostridium difficile-associated disease." Gut, Feb. 2008.

National Statistics. “Deaths involving MRSA and Clostridium difficile continue to rise.” Health Statistics Quarterly. United Kingdom. 20 February 2007.

Pennsylvania Health Care Cost Containment Council, “C. difficile Infections in Pennsylvania Hospitals.” PHC4 Research Briefs. 11 (May 2007): 1-4.

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Certain statements on this website are forward-looking statements that involve a number of risks and uncertainties. Such forward-looking statements include statements about CDI incidence, recurrence rates and costs and OPT-80’s drug profile. For such statements, Optimer claims the protection of the Private Securities Litigation Reform Act of 1995. Actual events or results may differ materially from Optimer's expectations. Factors that could cause actual results to differ materially from the forward-looking statements include, but are not limited to, the development of alternative methods for preventing or treating CDI and the timing, success and cost of Optimer's research and development related to OPT-80. Additional factors that could cause actual results to differ materially from those stated or implied by Optimer's forward-looking statements are disclosed in Optimer's filings with the Securities and Exchange Commission. These forward-looking statements represent Optimer's judgment as of the date the applicable section was last updated. Optimer disclaims any intent or obligation to update these forward-looking statements, other than as may be required under applicable law.

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