New mom Gina Del Re knew something was seriously wrong with her son Anthony. At one point, she was changing diapers every 15 minutes. His diaper rash was so bad that he was raw and bleeding. He could hardly sit up. Anthony tested positive for Clostridium difficile (c. diff), a vicious bacterial infection he had contracted after he was put on antibiotics for a staph infection.
His parents noticed an inflamed cuticle on Anthony’s middle finger which turned out to be Methicillin-resistant Staphylococcus aureus (MRSA). He was prescribed the antibiotics cefadroxil and then clindamycin to treat the infection. It was during this vulnerable period that Anthony’s risk of contracting c. diff, a particularly virulent bacterial infection, went up 8-10 fold, according to experts.
“A healthy populated colon can fight c. diff,” says Dr. L. Clifford McDonald, a medical epidemiologist specializing in Clostridium difficile infections and antibiotic resistance at the Centers for Disease Control and Prevention. But when it's allowed to thrive, “the illness produces toxins that cause diarrhea and can damage the colon. In children, the illness has been milder, but there have been some severe outcomes.”
Antibiotics and Your Bacterial Colony
C. diff is not normal in the bacterial colony. It’s found in just 5-10 percent of adult patients and it’s probably just passing through, according to Dr. McDonald. We’re not sure about the statistics for kids because of a lack of research, but according to the CDC, 73 percent of children diagnosed with pediatric c. diff had been prescribed antibiotics during the 12 weeks prior to their illness.
“We have more bacteria in and on our body than human cells, some make us sick and some we need for good health,” says Lauri Hicks, medical director for the Get Smart: Know When Antibiotics Work program at CDC. “Antibiotics kill both the good and the bad bacteria, making us more susceptible to c. diff.”
Half of all antibiotics prescribed, mostly for upper respiratory infections, are not necessary and the majority of those antibiotics are prescribed to children and older adults. These antibiotics disrupt normal bacteria in the gut, a disturbance which can last for weeks and even months after a patient takes them. Anthony was already immune-compromised because he was born with Shwachman-Diamond Syndrome, a disease that makes it difficult for his pancreas to break down foods. He had been in and out of the hospital since birth, ideal conditions for contracting c. diff. While in Anthony’s case, the antibiotics were warranted, the outcome was worse than the Del Res could ever have imagined.
When a Bacterial Infection Thrives
Antibiotics used to treat c. diff also disrupt the body’s bacterial colony, which may cause recurrence. Fecal transplants are an option if you’ve had a primary infection and then two recurrences. They're becoming a more popular treatment because they cure 80 percent of people with c. diff. While they’ve been used in children, they’re less common.
Pediatric c. diff is a growing public health threat, that according to the CDC, impacts 17,000 children per year. The numbers are increasing, a problem that is linked to too many kids being unnecessarily prescribed antibiotics.
“It’s more of a cultural and social issue than anything else,” says Christian John Lillis Executive Director of The Peggy Lillis Memorial Foundation, a nonprofit dedicated to educating the public about c. diff. “The primary issue here is that antibiotics are completely and utterly overprescribed. For too long we’ve thought that there was no downside to antibiotics, but there is.”
A Clear Downside
But we’re finding out that antibiotics can often do more harm than good. Antibiotics lead to more visits to the emergency room for adverse side effects than any other drugs. While adverse side effects like c. diff are less common from antibiotic use, rashes and diarrhea are far more common. Severe allergic reactions such as anaphylactic shock can also occur.
The infection thrives without oxygen, a condition characteristic of the intestines. C. diff can form spores, which allows it to persist in the environment for years and years. It’s resistant to antiseptics, the biggest of which is alcohol, though bleach does kill c diff. Like tetanus and botulism, c. diff thrives in soil.
Anthony has survived a second round of c. diff. but his parents worry about recurrence, which is a real problem among patients. “It happens in 20 percent of the cases because after treatment, you still remain colonized with the bacteria for two months. The lower intestinal bacteria are just starting to grow back. Antibodies of the toxins are also in your body so it’s a question about whether your body can develop a resistance to them or not,” says Dr. McDonald.
Parental vigilance can make a big difference in identifying and treating c. diff in kids. “If you think your child may have c. diff, contact the doctor that prescribed the antibiotics and see if your child needs to continue taking them,” says Lillis. “If it’s a mild case, your body may be able to replenish bacteria to fight the illness. Be an advocate for your child." And most of all says Lillis, avoid antibiotics unless they are absolutely and utterly a must.
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