Recurrent Clostridium difficile-associated diarrhea and colitis treated with Saccharomyces cerevisiae (Baker's yeast) in combination with antibiotic therapy: a case report.

Abstract

Antibiotic-associated diarrhea is common in both inpatient and outpatient settings, and 15% to 20% of the cases are caused by Clostridium difficile. 1 Al­ though antibiotic therapy with metronidazole or other agents is effective for most patients with C difficile-associated diarrhea, approximately 10% to 20% of patients receiving treatment for C difficile infection will experience a relapse following dis­ continuation of initial therapy,2 and relapses are often multiple. This clinical problem can be fre­ quent and frustrating. C difficile-associated diarrhea is thought to occur when an alteration of the normal bacterial flora of the intestinal tract permits proliferation of toxi­ genic strains of C difficile. Various microorganisms have been used therapeutically to repopulate the intestinal flora to enhance resistance against C dif ficile. A randomized placebo-controlled trial has shown that the yeast Saccharomyces boulardii is ef­ fective for the treatment of recurrent C difficile disease. 3 This biotherapeutic agent, however, is not available as a pharmaceutical preparation in the United States. We report herein a case of C difficile­ associated diarrhea with multiple relapses that re­ sponded to treatment with antibiotics together with a commercial baker's yeast (Fleischmann's Yeast), which contains the closely related species Saccharo­ myces cerevisiae at a concentration of organisms at 1 o to/g.