Case reportClostridium difficile toxoid vaccine in recurrent C. difficile-associated diarrhea
Section snippets
Entry criteria
An open-label study was performed in subjects with recurrent CDAD defined as a history of a change in bowel habit with 3 or more unformed bowel movements per day for at least 2 days, associated with a positive stool toxin test for C difficile (either tissue culture cytotoxin assay or toxin A or B enzyme immunoassay) that occurred within 30 days of discontinuation of therapy with metronidazole or oral vancomycin that had been administered for treatment of a prior episode of CDAD. Study inclusion
Case 1
A 51-year-old man presented to his primary care physician because of increased frequency of micturation and nocturia. He was found to have an elevated level of serum prostate-specific antigen and was treated with ciprofloxacin 500 mg, twice daily for 21 days for suspected chronic prostatitis. Further studies revealed a localized prostate lesion, and, in February 2001, he underwent transrectal prostate biopsy after enema preparation and an additional single prophylactic dose of ciprofloxacin 500
Discussion
Recurrent C difficile–associated diarrhea is a common clinical problem and affects as many as 35% of all patients treated for CDAD in our institution.23, 39 The management of patients with multiple recurrences is especially challenging.19 The subjects in this study are typical of such patients in that they had good control of symptoms for prolonged periods while taking vancomycin but repeatedly suffered recurrent diarrhea within a few days of attempting to discontinue this antibiotic. They had
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Drs. Kellly and Pothoulakis have acted as consultants or scientific advisors to companies, Bicodex Inc., GelTex Pharmaceuticals Inc., SynSorb Biotech Inc., and ActivBiotics Inc., interested in developing therapeutic intervention for C difficile diarrhea. Dr. Kyne acted as a consultant for GelTex Pharmaceuticals Inc. Drs. Giannasca, Warny, Lee, and Monath are employees and shareholders of Acamis Inc.
During this study, L. Kyne held a Paul Beeson Faculty Scholars in Aging Research career development award.
Supported by grants AG00971 (to L.K.), AI053069 (to C.P.K.), and RR01032 (to Beth Israel Deaconess Medical Center, General Clinical Research Center) from the National Institutes of Health and by Acambis, Inc.