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
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