The Curbsiders Internal Medicine Podcast #494 C. diff, Diarrhea, the Microbiome, and New Therapies with Dr. Cynthia Sears. Live from Johns Hopkins Grand Rounds
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Aug 11, 2025 In this lively discussion, Dr. Cynthia Sears, a professor at Johns Hopkins, unpacks the complexities of Clostridioides difficile (C. diff) infections and their impact on gut health. She breaks down the difference between C. diff colonization and infection, discusses treatment strategies, and highlights microbiome recovery tactics. The conversation also dives into the challenges of recurrent infections, the role of probiotics, and the potential of new therapies, including monoclonal antibodies and microbiota replacement. A must-listen for anyone interested in gut health!
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Objective Criteria For Severe Disease
- Define severe C. difficile by WBC >15,000 or creatinine >1.5 to guide escalation and admission.
- Use these objective markers alongside clinical assessment to decide inpatient care.
Fidaxomicin First, Avoid Metronidazole
- Prefer fidaxomicin to spare the microbiome; use oral vancomycin if fidaxomicin is unavailable.
- Avoid metronidazole for C. difficile because it's poorly targeted and linked to worse outcomes.
Diet And Fiber To Rebuild The Microbiome
- Encourage soluble fiber (psyllium) and DASH/Mediterranean-style diets to help microbiome recovery after C. difficile.
- Recommend kefir or fermented foods only if patients tolerate and enjoy them as adjuncts.