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Remicade infusion with C Diff

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Posted 3/2/2017 10:59 AM (GMT 0)
So I asked my doctor if I should reschedule my Remicade infusion tomorrow since I have C. Diff, and he says no, it's important to get my Remicade. This is my third loading dose.

I'm a little leery about this. Any input?

I'm doing better now, but not back to my normal, a week and a half into my two week Vancomycin regimen. I went from profuse watery D 8-9 times a day to mostly solid (some loose) BMs 2-3 times a day. But C. Diff scares the crap out of me, especially since this is the second time I've had it and it seems to be stronger this time.

If I reschedule the Remicade, can I pay catch-up with it later or does it not work that way?

Post Edited (Canaveral) : 3/2/2017 6:46:32 AM (GMT-7)

Posted 3/2/2017 12:53 PM (GMT 0)
If you have any active infection (like c diff) then you should delay your remicade infusion. Call and ask the infusion nurse at the center where you will get that infusion to confirm. Remicade is an immunosuppression med, and might make cdiff worse.

Yeah, once you're done with antibiotics then they can resume remicade. The point is to get enough remicade into your system to reach ideal therapeutic (healing) affect.
Posted 3/2/2017 1:15 PM (GMT 0)
Totally agree with iPoop.
Every time I've had C-Diff, had to push out my Remicade infusion until after I'm finished with the antibiotic. There is a Dr. at the infusion center who has seen my positive C-Diff results come through and contacted me about rescheduling my infusion.
Posted 3/2/2017 1:45 PM (GMT 0)
Ugh, my doctor is insisting that I still do the infusion tomorrow. I don't know what to do. sad
Posted 3/2/2017 5:00 PM (GMT 0)
Ahahah so I am all over your posts Canaveral ! Seems we have a lot in common recently :P
I think I said it before, but I may repeat myself to give you a complete answer to your question.

My case is very similar to yours. I had to stop Remicade because of the C-Diff infection and after exactly 2 weeks on antibiotics my GI make it very important that I do my infusion and do the loading protocol again from the start. I had already low IFX levels in fall and we all know that the chance of building Remicade antibodies after stopping are high. But there's not much biologics treatments and my GI wanted to make shure that we tried everything with Remicade.

With that being said, that's also what your GI is considering. He want to make sure you do the loading protocol properly, so you can quit Prednisone ASAP and not wasting the chance of making this biologic to work.

Yes it's a bit early with your C-diff, but it also means you'll still be on Vanco the days after your infusion which is good. When I did my perfusion, C-diff symptoms came back for few days (scary, I know), but because I was still on Vanco treatment, symptoms went away for good. I also did the next infusion 4 wks later without any Vanco and it went really well.

Good luck!
Posted 3/2/2017 5:53 PM (GMT 0)
I had remicade infusion while having cdiff due to concurrent flare.
Posted 3/2/2017 7:12 PM (GMT 0)
Okay, so my doctor said I could postpone my infusion a week and that one week wouldn't make a difference. Does anybody know if that's true? Is it possible that I'll mess up my chances of Remicade working if I postpone my third loading dose a week?
Posted 3/2/2017 9:46 PM (GMT 0)
Actually this topic came up at a conference and there was no consensus on what to do. Some of the top international GIs leaned toward delaying Remi infusions for a patient being treated for c.diff; while others thought that if IBD was active, the infusions should continue on schedule, as treating the underlying IBD *may* make it a little easier to treat the c.diff.

There really isn't sufficient solid data on Remicade or other anti-TNFs and concurrent c.diff infections to know one way or the other what to do. So it really comes down to the individual and the doctor.

The concern about taking Remi while having an infection applies in most cases (sinus infections, ear infections, lung infections, perhaps even other types of bacterial or fungal infections of the GI tract), but it may be over-ridden by other concerns in a person with IBD and c.diff.

They mostly agreed that one should avoid high doses of steroids while fighting a c.diff infection.
Posted 3/2/2017 10:57 PM (GMT 0)
I have always had to miss my biologic dose when I have c diff. It will make everything worse because you can't fight the infection off.
Posted 3/2/2017 11:25 PM (GMT 0)
But you really can't *fight the infection off* anyway, whether on Remicade or not. The immune response by itself struggles to control c.diff and won't clear c.diff. That's why antibiotics are needed.

And it's not clear whether or not the inflammatory pathway that Remicade blocks affects the immune response to c.diff, which may be an immune response that occurs via different molecular pathways.
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