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April 28, 1993

Clostridium difficile Colitis: Causes, Cures

Author Affiliations

Milwaukee, Wis

JAMA. 1993;269(16):2088. doi:10.1001/jama.1993.03500160053028

To the Editor.  —The considerable portion of the recent review of C difficile colitis by Fekety and Shah1 devoted to relapsing disease is a testament to the frustration of patients afflicted with this outcome of C difficile infection. Not discussed is an oral regimen using 125 mg of vancomycin hydrochloride four times per day and 600 mg of rifampin twice daily for 7 days. This approach has been successful in seven patients who had multiple relapses documented by bacteriophage typing.2 I have used this combination in an additional 15 patients with two or more relapses, all with no further clinical disease (unpublished observations). However, the mechanism of action is unknown. Virtually all isolates of C difficile are sensitive to both antibiotics, and synergy cannot be demonstrated.3 Not all recurrences are true relapses,4 and the simple re-treatment strategies suggested by Fekety and Shah and others5 should