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As reported on October 4, 2004, in Etopia Media Medical News Network #20: Hospital antibiotic use allows dangerous C. difficile to cause diarrhea and worse; profligate use encourages emergence of drug-resistant, more toxic versions, the overuse of powerful and expensive antibiotics relentlessly marketed by multinational drug companies seeking maximum profits has led to a counter-intuitive result: it's killing patients who go to hospitals to get well.

This is such a common problem that is has its own word: nosocomial. The Centers for Disease Control and Prevention have even set up the National Nosocomial Infections Surveillance System (NNIS) to keep track of it.

The problem is that these powerful pharmacological agents, when used against pneumonia and other diseases, often also kill more-benign micro-organisms populating the large intestine, where their presence keeps the dangerous Clostridium difficile (or C. difficile or C. diff.) bacterium at bay. Like poison gas used against Kurds or the Jingaweit and other genocidal agents used against Sudanese in Darfur these powerful drugs eliminate the microbiological competition and facilitate the proliferation of vicious bacteria that can cause diarrhea and, often, death.

C. diff. continues to break out in Canadian hospitals. An article appearing yesterday on the canada.com web site, reports that when Dr. Vivian Loo, author of a report on the impact of C. diff. in Canadian hospitals, was "asked at a news conference if the aggressive hospital-based strain had reached epidemic proportions, she replied: 'I would say this is an epidemic, yes. ' "

For more about the increasingly problematic C. diff. epidemic in Canada, click here.

Possibly fortunately, while some powerful medicines can generate lethal nosocomial infections, other pharmaceutical products may offer ways of laying waste the invading hordes of C. diff. as they seek to colonize patients' large intestines.

For example, Oscient Pharmaceuticals Corporation "is a biopharmaceutical company committed to the clinical development and commercialization of novel therapeutics to address unmet medical needs….The Company has a novel antibiotic candidate, Ramoplanin, in advanced clinical development for the treatment of Clostridium difficile-associated diarrhea (CDAD)."

An October 1, 2004, posting on BioWorld Online, The Worldwide Biotechnology News and Information Source, reports that "Vicuron's third product candidate, ramoplanin, is an oral non-absorbable form of antibiotic called a lipopeptide being developed by Waltham, Mass.-based Oscient Pharmaceuticals Corp., the licensee in North America. Oscient recently completed a Phase II trial of ramoplanin to treat Clostridium difficile-associated diarrhea, and expects to begin a Phase III trial in that indication by the end of the year."

Being "non-absorbable" is important in this context because the drug can go no further than the large intestine, where it's intended to destroy the C. diff. and therefore can't cause any other damage to the body elsewhere, which it might do if absorbed by the large intestine and allowed to enter the general circulatory system.

In case you were wondering, ramoplanin acts against the C. diff. by disrupting "bacterial cell wall construction by inhibiting glycosyltransferase- and transglycosylase-catalyzed peptidoglycan biosynthesis." You can read more about this in the announcement, from 2002, of the first "total synthesis" of ramoplanin, which was quite a feat, bio-chemically speaking.

For a definitive look at a description, in poster form, of "In vitro Activity of Ramoplanin Against Multidrug-Resistant Staphylococci and Enterococci," click here.

Powerful and complicated new antibiotics are not the only new agents being prepared to do battle against the rampant C. diff.. Fewer than 17 miles away from the Oscient laboratories in Waltham one can find the Massachusetts Biologic Laboratories (MBL) of the University of Massachusetts Medical School (UMMS), which, along with Princeton, New Jersey-based Medarex, "a biopharmaceutical company focused on the discovery and development of fully human antibody-based therapeutics to treat life- threatening and debilitating diseases, including cancer, inflammation, autoimmune and infectious diseases," on September 29, 2004, announced "the allowance of an Investigational New Drug (IND) application filed with the U.S. Food and Drug Administration (FDA) to initiate a Phase I clinical trial of CDA-1 (also referred to as MDX-066), a novel fully human monoclonal antibody designed to treat a serious and sometimes deadly form of diarrhea called Clostridium difficile associated diarrhea (CDAD), which can complicate the stays of hospitalized patients and residents of long-term care facilities."

For further details of this step in the laborious process of getting FDA approval for their means of treating C. diff., click here.

Rather than interfering with the construction of essential cell walls in the C. diff. bacterium, CDA-1 works "by binding to a toxin released by C. difficile, thereby forestalling the disease state that arises from the toxin's effect on the intestinal tract." There are, apparently, more than one way to skin a C. diff..

Readers of the previous Etopia Media Medical News Network article about C. diff. may remember that Dr. Clifford McDonald, the medical epidemiologist with the Centers for Disease Control and Prevention in Atlanta, who was interviewed about C. diff. in that story, said that more hand washing and more glove wearing in the hospital milieu could short-circuit the transmission cycle for C. diff..

A similar, higher-tech way of eliminating these bacteria in the hospital setting is the basis of some new anti-C. diff. products from Zapitall Inc., in St. Andrews by the Sea, New Brunswick, Canada.

Click on the title of this press release to learn more: "Zapitall Brings Affordable UVC Technology to Kill C. Difficile, Avian Bird Flu, Creutzfeldt-Jakob Disease, and More.".

For more about the avian flu, which Zapitall says it can kill as well as killing C. diff., go to: Etopia Media Medical News Network #30, from October 11, 2004, Could the bird flu virus H5N1 cause a 1918-class global influenza pandemic? and Etopia Media Medical News Network #31, from October 12, 2004, "De-certified regular flu maker Chiron got a contract with federal agency to make and test H5N1 (bird flu) virus as part of the national response to a possible global avian influenza pandemic and hasn't said if its decertification will interfere with carrying it out".

(Note: Two days after EMMNN #31 was posted, the National Institute of Allergies and Infectious Diseases (NIAID) answered the question: "Does Chiron closure affect avian flu contracts?" by saying:

"The H5N1 vaccine is being produced in Liverpool, England, however it is being produced in a completely separate facility than the facility currently under review by the regulatory authorities. Chiron has confirmed that it has permission from the regulatory authorities to continue its work on the H5N1 vaccine.")

If I were a C. diff. bacterium, I'd be seriously wondering if my days in the sun (actually in the large intestine) spreading havoc in Canadian (and other hospitals) were numbered, due to the coming onslaughts of these massively-engineered and eagerly-awaited medical measures designed to put an end to my trouble-making.