Antibiotics, Probiotics or Both for C. diff?

On May 27, 2011 a New York Times article reports that Sherwood Gorbach, a 71 year doctor, has been instrumental in the development of a new antibiotic, Dificid, also known as fidaxomicin, for treating C. difficle (C. diff) diarrhea. Dr. Gorbach spent most of his professional life as professor of medicine and public health at Tufts University. He is also well known in the natural health community as one of the co-inventors of a probiotic known as Lactobacillus GG  (GG stands for Drs. names: Sherwood Gorbach and Barry Golden).  So it is needless to say he is well versed in the use of probiotics.

The discovery and bringing to market of Dificid is no doubt a wonderful event. One reason is there are more antibiotic resistant C. diff strains due to the overuse of Flagyl and Vancocin which have been the mainstays for C. diff treatment. It is important to point out that there are many studies in the medical literature that show the concurrent use of probiotics or probiotic yogurts with antibiotics greatly reduce or prevent C. diff in the first place. 1 Also, prolonged use of probiotics after a C. diff infection reduces the likelihood of getting recurrent C. diff infections. What a novel concept—why not use probiotics and/or fermented yogurt on a regular basis?

It turns out that the Dificid, at this point in time being the “new kid on the block,” was shown to be much better than Vancocin in preventing recurrent C. diff. About 25 percent of the Vancocin users had a recurrence compared with only about 15 percent of the Dificid users. Why would this be?  It’s too soon and too new for resistant C. diff strains to develop! What’s more, Dificid like most prescription drugs, has its dark side—namely side effects of nausea, vomiting, abdominal pain and gastrointestinal hemorrhage. Now let’s talk about cost; the drug is likely to be at least as expensive as Vancocin, which costs $1,000 or more for a course of treatment. Optimer, the pharmaceutical company that sells Dificid, is predicted to make about $159 million per year after a few years of selling the drug.

If we really had a health care system in addition to a sickness care system, probiotics would be taken as seriously (if not more so) than antibiotics in both the prevention—and yes, the treatment—of most all infections. It would be interesting for both Dr Gorbach and the New York Times to tell the more complete story of how Dificid could be avoided, but if truly needed, be complemented with probiotics that would include multiple species and strains of Lactobacillus and Bifidobacteria in a high enough dose to really matter, several hundred billion probiotic bacteria per day.

  1. Hickson M, et al., “ Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial.” BMJ. 2007 Jul 14;335(7610):80. Epub 2007 Jun 29.
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