The search for a better treatment for recurrent Clostridium difficile disease: Use of high-dose vancomycin combined with Saccharomyces boulardii

Recurrent Clostridium difficile disease (CDD) is a difficult clinical probl em because antibiotic therapy often does not prevent further recurrences. I n a previous study, the biotherapeutic agent Saccharomyces boulardii was us ed in combination with standard antibiotics and was found to be effective i n reducing subsequent recurrences of CDD, In an effort to further refine a standard regimen, we tested patients receiving a regimen of a standard anti biotic for 10 days and then added either S, boulardii (1 g/day for 28 days) or placebo. A significant decrease in recurrences was observed only in pat ients treated with high-dose vancomycin (2 g/day) and S. boulardii (16.7%), compared with those who received high-dose vancomycin and placebo (50%; P = .05), No serious adverse reactions were observed in these patients. Compa rison of data from this trial with data from previous studies indicates tha t recurrent CDD may respond to a short course of high-dose vancomycin or to longer courses of low-dose vancomycin when either is combined with S. boul ardii.