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April 14, 1989

Oral Fluoroquinolone Therapy for Clostridium difficile Enterocolitis-Reply

Author Affiliations

Greenville (SC) Hospital System

Greenville (SC) Hospital System

JAMA. 1989;261(14):2064. doi:10.1001/jama.1989.03420140065017

In Reply.—  My report of two patients with C difficile toxin—positive diarrhea that resolved after simply changing from parenteral ceftriaxone therapy to oral ciprofloxacin therapy was not meant to advocate the use of fluoroquinolones for treatment of C difficile—associated enterocolitis but rather was intended to stimulate controlled investigation of an apparent lack of their association.I cannot reconcile my anecdotal experience with the case report of Dr Loge, but one could speculate that there might be variable sensitivity of C difficile strains to ciprofloxacin or perhaps that the antibiotic dose (750 vs 500 mg) or fecal antibiotic concentration played a role. Host factors such as age, concurrent gut flora, intrinsic intestinal disease, and other underlying illness also could contribute to induction or resolution of C difficile—associated disease.It seems that the pathogenesis of C difficile enterocolitis in individual cases remains poorly understood. There are reports of spontaneous occurrence