July 18, 2017 at 12:02 pm #690
62 yr old man, with type II DM had amoxicillin for tooth implant 7/2016 and not long after developed diarrhea. He hadn’t taken all of the amoxicillin and on his own decided to retake the Amoxicillin, which he thought made diarrhea better. However, it recurred. He then had a two-week course of rifaximin. Which worked a little but diarrhea recurred. He then finally consented to an OAT and a GIFX done within days of each other. The OAT markers were negative for clostridia, but Genova called with a critical result saying they had detected clostridia. He underwent Flagyl for >2 weeks, ending with every 3-day treatment. Diarrhea has continued intermittently. He had a PCR stool analysis that came back negative for clostridia.
Questions: You have mentioned the OAT tends to be more sensitive than stool testing–what do you make of the negative OAT and the positive GIFX? Do you think the clostridia could have been a false positive?
Any suggestions for further work up and treatment? He has a colonoscopy pending.
July 27, 2017 at 10:40 pm #696
I answered much of this on the QA tonight, but I think it is significant that the C. diff was found on stool testing. There are different strains of C. diff, and not all produce the 4-cresol that would be detected via the OAT.
I cannot say for sure whether the C. diff was a false positive. Usually, a lab may report a false negative versus a false positive.
C. difficle is best treated via a cyclical approach (as you tried with the Flagyl). Go back to the clostridia module and look at the information for the McFarland article using cyclical dosing of Vancocin (vancomycin). I would also put this person on CoreBiotic from Researched Nutritionals, available from New Beginnings Nutritionals too – http://www.nbnus.com. I would use 2 capsules at night.
If he failed Flagyl, then the next thing to try is Vancocin.
Also, if he is married have his significant other tested too. Clostridia spores are very resilient.
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