C Diff and antibiotic resistance in kids

A recent story from the UK reported a school child who developed diarrhea and tested positive for C difficile.

The alarming thing is that there did not seem to be any explicit risk factors for this. The appalling thing is the mis-information by the story that, “children rarely become ill with C diff, which normally strikes elderly people in hospital.”

This is how things used to be, before the BI/NAP1/027 bug evolved in the early first decade of the millenium. We and others have shown that kids are not immune from it, and neither are other people previously thought not to possess any risk factors for it. In fact, we have a paper coming out shortly in the CDC’s journal, Emerging Infectious Diseases, showing that in the US the rate of pediatric hospitalizations with C diff rose from 7.2 cases per 10,000 hospitalizations in 1997 to 12.8 cases/10,000 in 2006.

So why is this happening? Well, there are a couple of ways to answer this question. The proximal answer is that the new bug is better equipped to propagate. Its spore possesses greater stickiness than the old pathogenic version which we all knew and loved in the ’90s, and thus is more difficult to eradicate from fomites and anatomic surfaces. It also produces on the order of 20-times more of the toxins responsible for wreaking havoc in the colon. So, clearly, this is a bug for the new millenium.

But here is the real reason for this, albeit a little more removed: antibiotic overuse. All physicians are aware of this, and we all get the connection. The way this works is that C diff is impervious to many of the antibiotics employed to treat other infections, while its neighbors in the gut are decimated. Thus, C diff proliferates to fill the void and takes a firm hold under the right circumstances. The new superbug is, of course, very likely the result of the all-too-familiar saga of resistance evolution.

Here is the frightening part: we are still overusing antibiotics! I frequently hear from my friends that their MDs offered antibiotics for something that to me is clearly a non-bacterial issue. The most frustrating situation is when I am convinced that the friend has a post-viral reactive airways cough and needs an inhaler, but instead comes home with a handful of antibacterial pills. And no one wants to take the chance.  We are so risk averse that even when we are well educated about the perils of antibiotic overuse, we are still likely to take them if our doctor prescribes them.

And for a doctor, with the shrinking appointment times, what is the most expedient course, particularly with a patient with an entitled attitude? You guessed it, antibiotics!

So, what do we do? My feeling is that the action has to be multi-pronged. Yes, physicians need to be held accountable for their treatment choices, but so do patients. We need to do a much better job educating the public about the dark underbelly of antibiotics, so that they can be partners in these decision. In my opinion, this may be the most critical healthcare issue of our time, given the concerns raised by both the WHO and the FDA that, if resistance emergence continues at this pace, we will be back to the dark ages of pre-antibiotic era.

To this end, the Surgeon General should pick up the banner of antibiotic education. In fact, I recently sent her a letter outlining why she might want to make this a part of her Public Health agenda. If anyone is interested in making it a more public effort, I am happy to share it and resend with more signatures than just my own. She after all puts the “Public” into Public Health.

We have got to start talking to the people about this. The resistance train needs to reverse direction.

Marya Zilberberg is founder and CEO of EviMed Research Group and blogs at Healthcare, etc.

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  • http://www.medicalisland.net Dr. Lawrence Kindo

    The idea of antibiotic resistance is not a new phenomenon and we, physicians should be the first to adopt it and practice it to effect. The perils of antibiotic overuse is already in play with superbugs in the foray. Multi-drug resistant superbugs are increasingly being isolated in culture time and again to be ignored. It is time each of us took the extra step – it is not “they” who are doing it. Ultimately, it is the individual decision that makes it count. Hope the situation improves with time and deliberate action on our part.

  • http://www.brightonyourhealth.com Mary Brighton, MS, RD

    Too much antibiotic use among children. I was guilty of it too…Baby sick? off to the doctor…antibiotics…and thankfully they worked quickly as I could only take a certain amount of time off of work to take care of my sick child.
    Problem was: 3 weeks later, same ear infection…or same chest infection…antibiotics again. This happened for 5 months straight and 10 doses of antibiotics.
    Finally, switched my baby to soy formula (with a mix of 50% breastfeeding too), turns out she was allergic to the dairy formula and used cranial osteopathy which helped her ears drain fluids better.
    My doctor here in France tries other methods first (homeopathy), rather than antibiotics. And, when they need the antibiotics (recently due to scarlitina) I don’t hesitate to give them….They are rarely sick these days!
    Mary Brighton

  • pat

    I am not a doctor, but have been reading about this issue for some time. Also, I have a friend who practically has a standing order for antibiotics to treat her sinus infections. I have asked before whether she is ever tested to determine whether the infections are viral or bacterial, but apparently this is never done. Here is my opinion: we must develop another way of dealing with organisms we share the planet with other than killing them off if they’re bad for us. Basically, we can’t win a weapons race with Mother Nature. Maybe we can distract them, misguide them, deflect them or fake them out. Clearly, the killing paradigm does not work in the long run.

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