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On that same topic - why isn't NAC being used for C-Difficile?

AI response to "c-difficile "NAC"" search:

N-acetylcysteine (NAC) is an antioxidant that can help protect against the effects of Clostridium difficile (C. difficile) toxins. C. difficile is a bacterium that can cause antibiotic-associated diarrhea and pseudomembranous colitis. The majority of pathogenic strains of C. difficile secrete two large exotoxins, TcdA and TcdB, which can cause inflammation, tissue necrosis, and fluid secretion. NAC can help protect against the effects of these toxins in a few ways:

Reactive oxygen species (ROS)
NAC can reduce ROS levels, which can help prevent apoptosis and loss of viability in neuronal cells treated with toxin A. Chemical attenuation of ROS may be a viable strategy for protecting the colonic mucosa of patients with C. difficile infection (CDI).

Glutathione (GSH) levels
NAC can prevent the depletion of GSH levels in epithelial cells caused by C. difficile toxins. This depletion is important for the development and progression of cytopathology caused by the toxins. NAC can also prevent the toxins from causing rounding up and breakdown of the actin cytoskeleton.

also...

NAC prevents the oxidative imbalance induced by C. difficile toxins in epithelial cells. It is known that oxidative stress may be involved in several pathways leading to cellular retraction and rounding associated to the cytoskeletal rearrangement.Jun 18, 1999

https://www.sciencedirect.com/science/article/pii/S0014579399007061

Again from AI -

I asked "What causes c difficile infection?":

Clostridioides difficile (C. diff), also known as C. difficile, is a bacterium that can cause diarrhea and other intestinal conditions. C. diff is commonly found in the environment, including in the air, water, soil, and in the feces of humans and animals. C. diff infections can be caused by:

Antibiotics
Antibiotics can disrupt the balance of bacteria in the gut, allowing C. diff to overgrow and produce toxins that make a person sick. Broad-spectrum antibiotics are a particular risk factor.

Contaminated surfaces
C. diff bacteria outside the body turn into spores that can live on surfaces for weeks or months. These spores can be transmitted to patients if proper cleaning protocols are not in place, especially in healthcare facilities.

Contact with an infected person
C. diff can spread easily to other people through contact with feces from an infected person or contaminated surfaces.

Other risk factors for C. diff include: Being older, Being sicker, Having a suppressed immune system, and Staying in a hospital or long-term care facility.
Symptoms of C. diff infections include: Diarrhea, Fever, Stomach tenderness or pain, Loss of appetite, and Nausea.
C. diff is usually treatable with antibiotics, but in rare cases, fecal transplant or surgery may be needed. Even when treated with antibiotics, the infection may come back.

Current SOC for c-difficile per AI - sounds like a clusterf#ck:

I had a typo in my first request - "first like therapy for c.difficile" resulted in this:

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The first-line treatment for Clostridioides difficile (C. difficile) diarrhea is oral metronidazole, unless there are contraindications. However, some say that metronidazole is no longer recommended as first-line therapy for adults, and that its failure rate is increasing. For severe cases, initial therapy with vancomycin or fidaxomicin is recommended. Treatment is usually given orally and continued for 10–14 days.

AAFP
Clostridioides difficile Infection: Update on Management - AAFP
Feb 1, 2020 — For an initial episode of nonsevere C. difficile infection, oral vancomycin or oral fidaxomicin is recommended. Metronidazole is no longer recommended as first-line therapy for adults. Fecal microbiota transplantation is a reasonable treatment option with high cure rates in patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes. Good antibiotic stewardship is a key strategy to decrease rates of C. difficile infection.

NCBI
Management of Clostridium difficile Infection - PMC - NCBI
Recommended therapy for CDI includes oral metronidazole for mild cases and oral vancomycin or fidaxomicin for moderate to severe cases, each given for 10 to 14 days. For infection with spore-forming C difficile, this length of treatment may be insufficient to lead to cure; however, continuing antibiotics for longer periods of time may unfavorably alter the microbiome, preventing recovery. Treatment with metronidazole has been associated with an increasing failure rate, and the only clear recommended form of metronidazole for treatment of CDI is the intravenous formulation for patients unable to take oral medications.

NCBI
Current Treatment Options for Severe Clostridium difficile ...
The two most common drugs used to treat C. difficile are metronidazole (500 mg PO TID) and vancomycin (125 mg PO QID) for 10–14 days. The standard first-line therapy in both the inpatient and outpatient settings remains oral metronidazole, unless there are contraindications to the medicine such as first trimester of pregnancy or inability to tolerate it. For severe disease, initial therapy with vancomycin is now recommended (Table 1). In all patients with CDAD, inciting antibiotics should be discontinued, if possible, or changed to a regimen with a narrower spectrum. Antimotility agents should not be used, even in mild cases.

Minnesota Department of Health
CDI Treatment Clostridioides (Clostridium) difficile Toolkit for Long-term Care Facilities - MN Dept. of Health
Oct 5, 2022

National Institutes of Health (NIH) (.gov)
Clostridium difficile-associated colitis. - PMC - NCBI

First-line therapy for C. difficile diarrhea is restricted to metronidazole. Second-line therapy for treatment failure is vancomycin. For relapse, a second course of metronidazole is recommended; tapering courses of vancomycin and probiotics are used for multiple recurrences.
If treatment fails, second-line therapies include:
Vancomycin: For treatment failure
Metronidazole: For relapse
Fidaxomicin: For moderate to severe cases
Other treatment options include:

Fecal microbiota transplantation (FMT)
Also known as a stool transplant, FMT can be a reasonable option for patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes. FMT restores healthy intestinal bacteria by placing another person's stool in the colon. Research has shown that FMT has a success rate higher than 85% for treating C. difficile infections that keep coming back.

Bezlotoxumab
Might be considered in patients with a primary CDI episode and risk factors for CDI recurrence.
In addition to treatment, you can help prevent C. difficile infection by:
Only taking antibiotics when your health care professional prescribes them

Taking all antibiotics exactly as instructed
Never stopping taking an antibiotic without first talking with your health care professional
Washing your hands often with soap and water instead of hand sanitizer
Cleaning often-touched surfaces such as door knobs, sinks, and countertops with a disinfectant, such as bleach

"First line therapy" yielded even scarier results:

The first-line treatment for mild cases of Clostridioides difficile (C. difficile) infection, also known as Clostridium difficile-associated diarrhea (CDI), is oral metronidazole:
Metronidazole: The recommended dose is 500 mg orally, three times a day, for 10 days. However, metronidazole is not FDA-approved for severe infections, and its failure rate has been increasing. If a patient can't take oral metronidazole, such as during the first trimester of pregnancy, intravenous metronidazole is the only recommended form. Repeated or prolonged courses of metronidazole should be avoided because of the risk of cumulative and potentially irreversible neurotoxicity.

NCBI
Current Treatment Options for Severe Clostridium difficile ...
In short, clinical judgment is still very important in diagnosis. Go to: Treatment of Mild-to-Moderate Clostridium difficile–associated Disease. The two most common drugs used to treat C. difficile are metronidazole (500 mg PO TID) and vancomycin (125 mg PO QID) for 10–14 days. The standard first-line therapy in both the inpatient and outpatient settings remains oral metronidazole, unless there are contraindications to the medicine such as first trimester of pregnancy or inability to tolerate it. For severe disease, initial therapy with vancomycin is now recommended (Table 1).

NCBI
Management of Clostridium difficile Infection - PMC - NCBI
Recommended therapy for CDI includes oral metronidazole for mild cases and oral vancomycin or fidaxomicin for moderate to severe cases, each given for 10 to 14 days. For infection with spore-forming C difficile, this length of treatment may be insufficient to lead to cure; however, continuing antibiotics for longer periods of time may unfavorably alter the microbiome, preventing recovery. Treatment with metronidazole has been associated with an increasing failure rate, and the only clear recommended form of metronidazole for treatment of CDI is the intravenous formulation for patients unable to take oral medications.

IDSA
Clinical Practice Guidelines for Clostridium difficile Infection ... - IDSA
Feb 15, 2018 — The suggested dosage is metronidazole 500 mg orally 3 times per day for 10 days. Avoid repeated or prolonged courses due to risk of cumulative and potentially irreversible neurotoxicity (strong recommendation, moderate quality of evidence). (See Treatment section for definition of CDI severity.)

National Institutes of Health (NIH) (.gov)
Clostridium difficile-associated colitis. - PMC - NCBI
First-line therapy for C. difficile diarrhea is restricted to metronidazole. Second-line therapy for treatment failure is vancomycin. For relapse, a second course of metronidazole is recommended; tapering courses of vancomycin and probiotics are used for multiple recurrences.

Minnesota Department of Health
CDI Treatment Clostridioides (Clostridium) difficile Toolkit for Long-term Care Facilities - MN Dept. of Health
Oct 5, 2022
For moderate to severe cases, the first-line treatment is oral vancomycin or fidaxomicin for 10 to 14 days. For severe disease, vancomycin may be recommended as initial therapy.

If treatment fails, vancomycin may be used as a second-line therapy. For relapse, a second course of metronidazole may be recommended. For multiple recurrences, tapering courses of vancomycin and probiotics may be used.

Probiotics are supplements or foods that contain microorganisms to help maintain or improve the body's "good" bacteria. Fecal transplant (FMT) may also be an option in rare cases. FMT involves placing stool from a donor into the recipient's colon using special tubes inserted into the rectum. Donors are screened for medical conditions and infections, and their stool is screened for parasites, viruses, and other infectious bacteria before use. Research shows that FMT has a success rate of over 85% for treating recurring C. difficile infections.

WHAT HAPPENED TO THE NAC?????