CMAJ • February 15, 2005; 172 (4). doi:10.1503/cmaj.1041461.
© 2005 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

Treating C. difficile

Susan M. Poutanen and Andrew E. Simor

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ont.

We agree with Malvinder Parmar that the role of anion-binding resins in the treatment of CDAD needs to be studied further. Anion-binding resins, such as cholestyramine and colestipol, have been shown to bind C. difficile toxins1 and have consequently been proposed as potentially useful in the treatment of CDAD, as we mentioned in our review.2 Parmar also suggests that anion-binding resins may also bind C. difficile spores, but to the best of our knowledge, this phenomenon has not been described in published reports. Small numbers of mostly anecdotal reports of success and failure with the use of anion-binding resins in the treatment of CDAD have been published (summarized by Ariano and associates3), but no large randomized controlled trials have been completed to definitively determine the role of resins. Anion-binding resins have been shown to bind vancomycin1,4 and theoretically may bind other antibiotics such as metronidazole, although we are not aware of any published data specifically describing this. Given the possibility of antibiotic binding by resins, some authors have suggested not using anion-binding resins in the treatment of CDAD,5 whereas others recommend using them only if administered at different times from metronidazole or vancomycin.6 As Parmar suggests, more study is needed to address the optimal indication and timing of anion-binding resins in the treatment of CDAD.

Footnotes

Competing interests: None declared.


References

  1. Taylor NS, Bartlett JG. Binding of Clostridium difficile cytotoxin and vancomycin by anion-exchange resins. J Infect Dis 1980;141:92-7.[Medline]
  2. Poutanen SM, Simor AE. Clostridium difficile-associated diarrhea in adults. CMAJ 2004; 171(1):51-8.[Abstract/Free Full Text]
  3. Ariano RE, Zhanel GG, Harding GK. The role of anion-exchange resins in the treatment of antibiotic-associated pseudomembranous colitis. CMAJ 1990;142(10):1049-51.[Medline]
  4. Pantosti A, Luzzi I, Cardines R, Gianfrilli P. Comparison of the in vitro activities of teicoplanin and vancomycin against Clostridium difficile and their interactions with cholestyramine. Antimicrob Agents Chemother 1985;28:847-8.[Abstract/Free Full Text]
  5. Wilcox MH. Treatment of Clostridium difficile infection. J Antimicrob Chemother 1998;41:41-6.[Abstract/Free Full Text]
  6. Malnick SD, Zimhony O. Treatment of Clostridium difficile-associated diarrhea. Ann Pharmacother 2002;36:1767-75.[Abstract]




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