Clostridium difficile-Associated Diarrhea and Colitis
Antibiotic-associated diarrhea is common in both inpatient and outpatient settings, and 15% to 20% of the cases are caused by Clostridium difficile. Although antibiotic therapy with metronidazole or other agents is effective for most patients with C difficile-associated diarrhea, approximately 10% to 20% of patients receiving treatment for C difficile infection will experience a relapse following discontinuation of initial therapy, and relapses are often multiple. This clinical problem can be frequent and frustrating.

C difficile-associated diarrhea is thought to occur when an alteration of the normal bacterial flora of the intestinal tract permits proliferation of toxigenic strains of C difficile. Various microorganisms have been used therapeutically to repopulate the intestinal flora to enhance resistance against C difficile. A randomized placebo-controlled trial has shown that the yeast Saccharomyces boulardii is effective for the treatment of recurrent C difficile disease. This biotherapeutic agent, however, is not available as a pharmaceutical preparation in the United States. We report herein a case of C difficile-associated diarrhea with multiple relapses that responded to treatment with antibiotics together with a commercial baker's yeast (Fleischmann's Yeast), which contains the closely related species Saccharomyces cerevisiae at a concentration of organisms at 10/g.