From the Guidelines
To minimize the risk of Clostridioides difficile (C. diff) infection when using antibiotics, healthcare providers should prescribe antibiotics only when necessary and select the narrowest spectrum antibiotic appropriate for the specific infection, as recommended by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. Antibiotics with higher C. diff risk include fluoroquinolones (ciprofloxacin, levofloxacin), clindamycin, third-generation cephalosporins (ceftriaxone), and broad-spectrum penicillins. When possible, use lower-risk alternatives such as doxycycline, trimethoprim-sulfamethoxazole, or nitrofurantoin for appropriate infections. Limit antibiotic duration to the shortest effective course; for many common infections, 5-7 days is sufficient rather than traditional 10-14 day courses. During antibiotic treatment, practice meticulous hand hygiene with soap and water (alcohol-based sanitizers are less effective against C. diff spores) 1. Probiotics containing Lactobacillus or Saccharomyces boulardii may help maintain gut flora balance during antibiotic treatment, though evidence varies 1. These measures help preserve the normal intestinal microbiome, which provides colonization resistance against C. diff. When the protective gut bacteria are disrupted by antibiotics, C. diff can proliferate and produce toxins that cause inflammation and diarrhea, so maintaining this natural defense is crucial for prevention. Key considerations include:
- Minimizing the frequency and duration of high-risk antibiotic therapy and the number of antibiotic agents prescribed, to reduce CDI risk 1
- Implementing an antibiotic stewardship program 1
- Targeting antibiotics based on local epidemiology and C. difficile strains present 1
- Restricting fluoroquinolones, clindamycin, and cephalosporins (except for surgical antibiotic prophylaxis) 1
- Using probiotics, such as Saccharomyces boulardii, to prevent C. difficile infection in patients at high risk 1.
From the FDA Drug Label
The bactericidal action of vancomycin against Staphylococcus aureus and the vegetative cells of Clostridium difficile results primarily from inhibition of cell-wall biosynthesis. In addition, vancomycin alters bacterial-cell-membrane permeability and RNA synthesis.
The FDA drug label does not answer the question.
From the Research
Minimizing the Risk of C diff when Using Antibiotics
To minimize the risk of Clostridioides difficile (C diff) when using antibiotics, several strategies can be considered:
- Probiotics: The use of probiotics, such as Lactobacillus-containing probiotic mixtures and Saccharomyces boulardii, may be effective in preventing C diff in high-risk antibiotic recipients 2, 3, 4, 5.
- Antibiotic Stewardship: Rational use of antibiotics can help reduce the risk of C diff by minimizing the disruption of the normal gut microbiota 6.
- Fecal Microbiota Transplantation: Fecal microbiota transplantation (FMT) is a promising therapy for C diff, and refinements to FMT are being developed, including quality-controlled stool products and purified Firmicutes spores 6, 3.
- Prebiotics: Combining probiotics with prebiotics may improve the growth and engraftment of beneficial microorganisms in the gut 3.
- Specific Probiotic Strains: Certain probiotic strains, such as Bacillus clausii and Lactobacillus reuteri, have been shown to secrete compounds that directly inhibit C diff 3.
- Nontoxigenic C diff: The use of nontoxigenic C diff strains may provide nutritional niche competition and prevent C diff infection 3.
Key Considerations
When considering the use of probiotics to prevent C diff, it is essential to note that:
- The evidence is based on small, individual studies, and further larger, well-controlled studies are needed to confirm preliminary positive findings 2.
- The safety and efficacy of probiotics in preventing C diff are still uncertain, and more research is needed to fully understand their role 3, 4, 5.
- Patients who are immunosuppressed or debilitated may be at risk of complications from probiotic use, and the risks may outweigh the benefits 5.