NEW YORK, Nov 30 -- The use of a common antibiotic is a risk factor for infection with diarrhea-causing bacteria, according to a report published in the November 25th issue of The New England Journal of Medicine.
A strain of the bacteria Clostridium difficile (C. difficile) set off
outbreaks of severe diarrhea in hospitals in New York, Arizona, Massachusetts,
and Florida between 1989 and 1992, researchers report. The findings may force
doctors to make changes in their antibiotic-prescribing patterns.
C. difficile destroys cells in the intestines, causing diarrhea. It
typically affects people who have been taking antibiotics, because these
medications kill beneficial bacteria in the intestines, which allows C.
difficile to overgrow.
Many patients affected by the hospital outbreaks of diarrhea had been
given the antibiotic clindamycin for other infections, according to Dr. Stuart
Johnson, of Northwestern University Medical School in Chicago, Illinois, and
colleagues.
The research team reports that between 1989 and 1992, there were 174 cases
of C. difficile infection in New York, 101 in Arizona, 106 in Florida, and 98 in
Massachusetts. In New York, 55% of cases were associated with clindamycin use,
as were 45% in Arizona and 30% in Massachusetts. The team did not analyze the
cause of the cases in Florida hospitals.
A second problem is that frequent use of an antibiotic such as clindamycin
can cause bacteria to become insensitive to the drug's effects, a problem known
as antibiotic resistance.
"Resistance to clindamycin further increases the risk of C.
difficile-associated diarrhea," the investigators conclude.
Doctors may need to make "radical changes in their antibiotic-prescribing
practices, even if it means forsaking some of their favorite antibiotics," Dr.
Sherwood Gorbach, of Tufts University School of Medicine in Boston,
Massachusetts, writes in an accompanying editorial.
Doctors may need to consider making such changes "in the near future,"
Gorbach adds, "as the epidemic of C. difficile diarrhea continues to grow in our
healthcare institutions."
