Dimitri M. Drekonja, MD, MS; Mary Butler, PhD, MBA; Roderick MacDonald, MS; Donna Bliss, PhD, RN; Gregory A. Filice, MD; Thomas S. Rector, PhD; Timothy J. Wilt, MD, MPH
Note: A clinician's guide and consumer guide, produced by AHRQ, are available online (Supplements).
Disclaimer: The authors are responsible for the content of the report. Statements should not be construed as endorsements by AHRQ or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Indulus Rutks and James Tacklind for their technical expertise in the preparation of this manuscript.
Grant Support: By contract HHSA 290 2007 10064 I from AHRQ, U.S. Department of Health and Human Services, and a Veterans Affairs Career Development Award through the Minneapolis Veterans Affairs Center for Epidemiological and Clinical Research (Dr. Drekonja) and Veterans Affairs Health Services Research and Development Service grant HFP-98-001 (Dr. Rector).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1356.
Requests for Single Reprints: Dimitri M. Drekonja, MD, MS, Infectious Disease Section (111F), Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Minneapolis, MN 55417; e-mail, email@example.com.
Current Author Addresses: Drs. Drekonja and Filice: Infectious Disease Section (111F), Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Minneapolis, MN 55417.
Dr. Butler: Division of Health Policy and Management, University of Minnesota, D330-4 Mayo Building, Minneapolis, MN 55455.
Mr. MacDonald and Dr. Wilt: Center for Chronic Disease Outcomes Research (111-0), Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Minneapolis, MN 55417.
Dr. Bliss: University of Minnesota School of Nursing, 6-189A WDH, 308 Harvard Street SE, Minneapolis, MN 55455.
Dr. Rector: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, 152/2E, One Veterans Drive, Minneapolis, MN 55417.
Author Contributions: Conception and design: D.M. Drekonja, M. Butler, D. Bliss, G.A. Filice, T.J. Wilt.
Analysis and interpretation of the data: D.M. Drekonja, M. Butler, R. MacDonald, D. Bliss, G.A. Filice, T.S. Rector, T.J. Wilt.
Drafting of the article: D.M. Drekonja, M. Butler, R. MacDonald, D. Bliss, G.A. Filice.
Critical revision of the article for important intellectual content: D.M. Drekonja, M. Butler, D. Bliss, G.A. Filice, T.S. Rector, T.J. Wilt.
Final approval of the article: D.M. Drekonja, M. Butler, D. Bliss, T.S. Rector, T.J. Wilt.
Provision of study materials or patients: R. MacDonald.
Statistical expertise: R. MacDonald, T.S. Rector, T.J. Wilt.
Obtaining of funding: T.J. Wilt.
Collection and assembly of data: D.M. Drekonja, M. Butler, R. MacDonald, D. Bliss.
Administrative, technical, or logistic support: T.J. Wilt.
Drekonja DM, Butler M, MacDonald R, Bliss D, Filice GA, Rector TS, et al. Comparative Effectiveness of Clostridium difficile Treatments: A Systematic Review. Ann Intern Med. 2011;155:839-847. doi: 10.7326/0003-4819-155-12-201112200-00007
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Published: Ann Intern Med. 2011;155(12):839-847.
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Martin H., Floch, Clinical Professor of Medicine
Yale University School of Medicine
December 30, 2011
Probiotics and fecal microbial transplants are treatments for Clostridium difficile infection
To the Editor:
Probiotics and fecal microbial transplants are treatments for Clostridium difficile infection.
In the December 20, 2011 issue of the Annals, the article entitled "Comparative Effectiveness of Clostridium difficile Treatments. A Systemic Review" as published by Drekonja and colleagues reports on a systemic review of antibiotic therapy but makes no mention of other treatments for recurrent and severe Clostridia difficile diarrhea infection. It is surprising that their discussion does not mention these treatments. Although there is controversy, the literature and studies in many institutions revealed that Saccharomyces boulardii and Lactobacillus GG have been reported repeatedly to be helpful in recurrent Clostridia difficile infection (1-3). Furthermore, the use of fecal microbial transplant (FMT) is now demonstrating surprising cures in patients with severe and resistant C. difficile infection. The review article published in the Annals leaves the reader with the impression that only antibiotics are treatments for this severe infection. Certainly, these other modalities of treatment, probiotics and FMT, are important and at times have been shown to be life-saving (4,5). They certainly should be mentioned at least in the discussion, and I would hope that the authors will correct the erroneous impression from this systemic review of antibiotics that only antibiotics are helpful in the treatment of Clostridia difficile.
1. Floch MH, Madsen KK, Jenkins DJA, et al. Recommendations for probiotic use. J Clin Gastroenterol 2006;40:275-278
2. Floch MH, Walker WA, Guandalini S, et al. Recommendations for probiotic use-2008. J Clin Gastroenterol 2008;42:S104-S108
3. Floch MH, Walker WA, Madsen K, et al. Recommendations for probiotic use -2011 Update. J Clin Gastroenterol 2011;45:S168-S171
4. Brandt L, Reddy SS. Fecal microbiota transplantation for recurrent Clostridium difficile infection. J Clin Gastroenterol 2001:45:S159-S167
5. Persky SE, Brandt LJ. Treatment of recurrent Clostridium difficile- associated diarrhea by administration of donated stool directly through a colonscope. Am J Gastroenterol 2000;95:3283-3295
Gastroenterology/Hepatology, Infectious Disease, Healthcare Delivery and Policy, High Value Care, Diarrhea.
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