banschbach@vms.ocom.okstate.edu writes:  >to candida blooms following the use of broad-spectrum antibiotics?  Gorden  >Rubenfeld, through e-mail, has assured me that most physicians recognize  >the chance of candida blooms occuring after broad-spectrum antibiotic use  >and they therefore reinnoculate their patients with *good* bacteria to  >restore competetion for candida in the body.  I do not believe that this is  >yet a standard part of medical practice.      Nor is it mine.  What I tried to explain to Marty was that it is clearly understood that antibiotic exposure is a risk factor for fungal infections - which is not the same as saying bacteria prevent fungal infections.  Marty made this sound like a secret  known only to veternarians and biochemists.  Anyone who has treated a urinary tract infection knowns this. At some centers pre-op liver transplant patients receive bowel decontamination directed at retaining "good" anaerobic flora in an attempt to prevent fungal colonization in this soon-to-be high risk group.  I also use lactobacillus to treat enteral nutrition associated diarrhea (that may be in part due to alterations in gut flora).  However, it is NOT part of my routine practice to "reinnoculate" patients with "good" bacteria after antibiotics.  I have seen no data on this practice preventing or treating fungal infections in at risk patients.  Whether or not it is a "logical extension" from the available observations I'll leave to those of you who base strong opinions and argue over such speculations in the absence of clinical trials.    One place such therapy has been described is in treating particularly recalcitrant cases of C. difficile colitis (NOT a fungal infection). There are case reports of using stool (ie someone elses) enemas to repopulate the patients flora.  Don't try this at home.   >not give give her advise to use the OTC anti-fungal creams.  Since candida  >colonizes primarily in the ano-rectal area, GI symptoms should be more common  >than vaginal problems after broad-spectrum antibiotic use.    Except that it isn't. At least symptomatically apparent disease.  >Medicine has not, and probalby never will be, practiced this way.  There  >has always been the use of conventional wisdom.  A very good example is  >kidney stones.  Conventional wisdom(because clinical trails have not been  >done to come up with an effective prevention), was that restricitng the  >intake of calcium and oxalates was the best way to prevent kidney stones  >from forming.  Clinical trials focused on drugs or ultrasonic blasts to  >breakdown the stone once it formed.  Through the recent New England J of  >Medicine article, we now know that conventional wisdom was wrong,  >increasing calcium intake is better at preventing stone formation than is  >restricting calcium intake.    Seems like this is an excellent argument for ignoring anecdotal conventional wisdom (a euphemism for no data) and doing a good clinical trial, like:   AU   Dismukes-W-E.  Wade-J-S.  Lee-J-Y.  Dockery-B-K.  Hain-J-D. TI   A randomized, double-blind trial of nystatin therapy for the      candidiasis hypersensitivity syndrome [see comments] SO   N-Engl-J-Med.  1990 Dec 20.  323(25).  P 1717-23.      psychological tests. RESULTS. The three active-treatment regimens      and the all-placebo regimen      significantly reduced both vaginal and systemic symptoms (P less than      0.001), but nystatin did not reduce the systemic symptoms      significantly more than placebo. [ . . . ]      CONCLUSIONS. In women with presumed candidiasis      hypersensitivity syndrome, nystatin does not reduce systemic or      psychological symptoms significantly more than placebo. Consequently,      the empirical recommendation of long-term nystatin therapy for such      women appears to be unwarranted.    Does this trial address every issue raised here, no.  Jon Noring was not surprised at this negative trial since they didn't use *Sporanox* (despite Crook's recommendation for Nystatin).  Maybe they didn't avoid those carbohydrates . . .   >The conventional wisdom in animal husbandry has been that animals need to  >be reinnoculated with *good* bacteria after coming off antibiotic therapy. >If it makes sense for livestock, why doesn't it make sense for humans  >David?  We are not talking about a dangerous treatment(unless you consider  >yogurt dangerous).  If this were a standard part of medical practice, as  >Gordon R. says it is, then the incidence of GI distress and vaginal yeast  >infections should decline.    Marty, you've also changed the terrain of the discussion from empiric itraconazole for undocumented chronic fungal sinusitis with systemic hypersensitivity symptoms (Noring syndrome) to the yoghurt and vitamin therapy of undocumented candida enteritis (Elaine Palmer syndrome) with systemic symptoms.  There is significant difference between the cost and risk of these two empiric therapeutic trials.  Are we talking about "real" candida infections, the whole "yeast connection" hypothesis, the efficacy of routine bacterial repopulation in humans, or the ability of anecdotally effective therapies (challenged by a negative randomized trial) to confirm an etiologic hypothesis (post hoc ergo propter hoc).  We can't seem to focus in on a disease, a therapy, or a hypothesis under discussion.