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The Economics of Prefilled Syringes - August 2017 - Outpatient Surgery Magazine

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That translates to hundreds of thousands of patients, and it under- scores a phenomenon that's both grave and confounding. Not only do most antibiotics fail to eliminate C. diff — antibiotics are actually the root of the problem. By disrupting the normal community of bac- teria in the intestines, they allow C. diff to flourish, resulting in infections that range in severity from bothersome to deadly. Grasping for treatments, providers have turned to vancomycin and probiotics, both of which have proven only marginally effective. Fecal transplants have had a remarkable success rate of about 80% or high- er for resolution of recurrent C. diff, says James D. Lewis, MD, MSCE, one of the study's authors and a professor of medicine and epidemiol- ogy at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pa. And that rate seems to hold true, he says, regardless of how the transplants are delivered — via colonoscopy, upper endoscopy, naso- gastric tubes or so-called poop pills in tablet form. The treatments also appear to be perfectly safe, at least in the short term. "But one of the points we make in our study is that we don't have a great understanding of what the long-term implications might be," says Dr. Lewis. "As far as I know, no one has definitively shown any long-term negative sequalae, but it's important that we continue to compile data and make sure we understand the long-term safety pro- file." Fecal transplants have gained considerable popularity over the last decade, and always include screening for any known infec- tious diseases, but there are billions of bacteria and other microor- ganisms living in the human gut, so there's always at least the theo- retical possibility of transmitting a disease not known to be infec- tious. That, along, perhaps, with the ick factor, is why many scien- tists and companies are trying to grow reagent-grade bacteria in A U G U S T 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 1 0 9

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