Overuse of antibiotics behind rise in C Diff and faecal microbiota transplants are the answer


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Cases of Clostridium Difficile infection (C Diff) are on the rise in the UK after many years of decline.

Incidence rose by 6% last year from 13,361 in 2013/14 to 14,165 in 2014/15. This worrying statistic is sure to alarm members of the public as well as the medical community and has understandably provoked some media attention.

It is unhelpful that the Daily Mail, which is the second most read newspaper in the UK, has unwisely linked the relaxation of hygiene rules in hospitals as being behind the statistics.

This is misleading and focuses attention away from where we should really be looking.

It is telling that at the end of the article the Mail quoted an NHS England spokesman as saying: ‘The NHS has managed to reduce C.difficile infections by 75 per cent since 2007/08 and not all remaining infections are preventable, with many picked up outside of hospital.’ We believe if the reader ignored the previous couple of hundred words and went straight to that NHS comment he or she would have a better handle on the situation.

The fact is C. Diff rates have been decreasing and as the spokesman said, it is true that the majority of cases are no longer due to transmission within a hospital environment.

Instead C. Diff resides benignly in the gut of many individuals and this hideous disease is instead awoken following extensive antibiotic treatment. This means that tight hygiene measures to prevent transmission would have very little effect on reducing incidence of the disease.

The relaxation of sanctions was part of an effort by the NHS to encourage hospitals to investigate C. Diff infections with a view to developing a greater understanding of individual causes.

It is estimated that around 3% of the population carry C.Diff without disease, but when there is an assault by the cocktails of antibiotics that are too often prescribed, it decimates the healthy flora in their gut and allows C. Diff to multiply and wreak havoc within the bacterial ecosystem. When this happens, the normally harmless C. Diff will change its gene expression and become pathogenic; in other words disease-causing.

Really, the only sensible way to treat this is to repopulate the gut with a Faecal Microbiota Transplant, restoring the healthy bacterial ecosystem and suppressing the ability of C. Diff to cause disease. As things currently stand this is only accepted as a treatment for recurrent C. Diff, which is resistant to antibiotics.

It’s very frustrating that the first line of treatment is to administer yet more antibiotics, which exacerbates the problem in many cases.

We at the Taymount Clinic are not anti-antibiotic, they are of course essential in many situations. However, simply using FMT as the first line approach would make C. Diff infections lasting longer than three days very rare.

Considering the current 8% mortality rate of C. Diff and the vast body of evidence supporting FMT for C. Diff, with cure rates well over 90%, we believe more could be done by the NHS.

We hope the NHS listens to us and others within our field as the sooner they do the sooner this disease can be beaten.

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