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very generally speaking, in my quite limited experience... (perhaps JPG or missash can elaborate, as I know these two have several decades of experience on me...)


I just rotated through the ICU, and they were pretty clueless has to how to handle flagyl (metronidazole), and vanco resistant CDiff. I actually bookmarked one of JPGs posts aout vanco in the ICU setting for CDiff (11/25/07), more on this later. As for the ICU I was just in, we would throw the kitchen sink worth of antibiotics at vanco resistant CDiff, we didnt have a choice (Zyvox, Suprax, tetracycline, cubicin, to name a few)

so, here's the big problem....
1) Cdiff normally resides in your intestines.
2) use of antibiotics dramatically increases risk of cdiff infection as you kill off everything else but cdiff in your gut. (thus, as people live longer and are exposed to more and more antibiotics, and more and more bacteria the more they visit a healthcare facility, the more prone they are to these worse infections (VRE, MRSA, vanco-resistant Cdiff, etc)
3) an increasing lifespan along with the maturation of ICUs increases the risk for resistant Cdiff for reasons outlined above.
4) .... there are only 2 drugs that are thrown at CDiff- flagyl and vanco. last year, there were few vanco resisistant strains, now, as many as 25% of strains are vanco resistant.

..... 5) bad diarrhea when a patient has been on antibiotics is often assumed to be because of CDiff, and almost always vanco or flagyl is started empirically & immediately.

and finally.... even ICU folks are not acutely aware of something other than vanco to throw at CDiff. I'd wait to be sure that one of these end up in an "algorithm" to treat CDiff, or in a medical ICU journal that heavily recommends usage of an antibody.



"Dr Watson said: "Clostridium difficile costs Europe £1billion a year in healthcare costs. You could view that as saved money or saved beds.""
.... http://www.dailymail.co.uk/health/article-510758/Jab-beat-C-...

I think that is a hugely inflated number, and I dont believe there is a vaccine on the horizon that will be heavily used in the US within the next 5-8 years.... however, I do believe that the actual amount spent on antibiotic treatment warrants a market value higher than OPTR is fetching.

what OPTR, or any other CDiff mab maker does NOT need is this: some ICU journal making recommendations against their use the way that the American Diabetes Association recommended against using new agents like Byetta. If an ICU journal puts out a strong rec for it, and an ICU has good results after using it, the medical/surgical floors will soon follow. Its going to be awhile, but just a year ago consider what JPG wrote:

"We haven't had an ICU death in over 6 months since we started giving high dose vanco early and enterally. " (http://boards.fool.com/Message.asp?mid=26129179)... now, there are numerous reported cases of vanco resistant cdiff.

unfortunately, I dont follow ICU magazines closely. I can check my prescriber's letter monthly but thats about it. (its a "cheat sheet" for those that write prescriptions on the latest literature with the latest recommendations from various governing bodies)...


Lastly, one thing to keep in the back of your mind. Just in case you miss the boat on Cdiff mabs, there is a strong association with VRE and vanco-resistant Cdiff. So, a VRE (vanco-resistant enterococcus) mab may be useful (http://www.ingentaconnect.com/content/bsc/ajg/2000/00000095/... , a bit dated, sorry). Just a thought.



Cheers to all. Good Luck investing in 2009!
-Fuma
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