Double Therapy promising treatment of Tuberculosis with C. Difficile, finds study

Clostridiun difficile infecton (CDI) is a major hospital problem, associated with long time antibiotic treatment. Clostridium difficile colitis results from a disturbance of the normal bacterial flora of the colon and the release of toxins that cause mucosal inflammation and damage.

The aim of the present study was to underlie the percent of TB patients affected by CDI, the impact of CDI in tuberculosis (TB) evolution, length of hospitalization and the effect of treatment on CDI recurrences.

To do the same, a team, led by Mara Popescu-Hagen,undertook a observational, retrospective study in the Institute of Pneumology "Marius Nasta" from March 2018 to May 2019, on 29 patients (17 men, 12 wemen) with tuberculosis and Clostridium difficile infection.

CDI was diagnosed by an immunoenzymatic assay (C. difficile TOX A/B II) for patients who developed diarrhea. The clinical data collected in this study were age, clinical characteristics, length of hospitalization, CDI treatment, comorbidities, medication history, and the use of antibiotics, especially anti-tuberculosis medication.

All TB patients (mean age 57.1 years) confirmed with CDI were included in the study. Stool characteristics, frequency of defecation, abdominal pain, treatment and relapses of CDI were monitored.

On data analysis, the following facts emerged.

• Most patients in the study group had a diarrheal episode within 3 weeks of initiating DOTS treatment.
• Abdominal pain and cramps were present in all 29 patients, 41.38% of patients experienced the altered general condition.
• None of these cases have received treatment with proton pump inhibitors in the last 3 months prior to the onset of disease.17 patients already had a previous hospital admission before the first diarrheal episode.
• Of these 17 patients, 14 had relapses of C. difficile infection,
• The age group over 70 is predominantly affected. Analyzing the relationship between the regimen used and the number of recurrences related to each category in the group of 29 patients, it emerged that there were 7 patients in whom Metronidazole was used as the only antibiotic.
• Of these, 6 had relapses of C. difficile infection. Treatment with Vancomycin was given to 7 patients, of whom 6 relapses.
• The fewest relapses, 4 out of 13 cases, were in those treated with double therapy, Metronidazole in combination with Vancomycin.

Taking a cue from the results, the researcherd concluded that," The fewest relapses were in patients treated with double therapy, with 30.77% of all those who benefited from this regimen. The length of hospitalization of cases with TB and CDI has been 56 days. The judicious prescription of antibiotic treatments with large specter and studies about initial double therapy of CDI in TB patients must be continued."

For full story follow the link: https://doi.org/10.1016/j.chest.2020.09.044

Primary source: CHEST 2020 Annual Meeting.