4 C.Diff Flashcards
why have drug guidelines (3)
1 to improve overall clinical management
2 to provide a standard of care to measure against
3 because the D of H say so
how can guidelines be implemented (3)
websites, pocket guides, smartphone apps
what is C.diff
clostridium difficile are anaerobic gram positive spore-forming rods present in the gut of up to 3% of healthy adults, but are inhibited by normal gut flora. Spores are like seeds and can last in an environment for weeks/months
describe the C.diff cycle
the stomach kills vegetative bacteria, spores travel to intestine and germinate, with altered gut flora they can colonise, produce toxins and disease. Excreted to the environment to cause further environmental contamination
C.diff infection context and symptoms
generally in elderly and those who have had recent antibiotic use
symptoms= diarrhoea (BSC 6-7), often with mucus, distinctive smell, inflammatory markers may be raised, elderly may be confused
C.diff disease spectrum
mild disease= self-limiting
severe disease= pseudomembraneous colitis, damaged mucosa, clinical signs= abnormal distension, diarrhoea, high white cell count
describe C.diff management
stool sample for toxin
patient isolation, perfect hand hygiene
stool chart and daily monitoring of stools
stop offending antibiotics
review drugs that may cause diarrhoea (e.g. PPIs, laxatives)
avoid loperamide and opioids
standard C.diff treatments and why oral not I.V.
vancomycin (main, oral since doesn’t pass through gut) or fidaxomicin (use in severe disease and recurrence, expensive).
C.diff is infection within gut lumen, and some drugs can’t pass through the gut so oral is more effective than I.V)
emerging C.diff therapy
rifaximin (post vancomycin to reduce relapse), IV immunoglobulins, bezlotoxumab, faecal microbiota transplants
other risk factors for C.diff infection
nasogastric tubes, PPIs (raise stomach pH)
reducing risk of C.diff infection in antibiotic use
use only if a known infection, use narrow spectrum agents, use shortest duration possible
what are aminoglycosides effective against
most gram negative bacteria and S.Aureus
give an example and describe aminoglycoside therapeutic window
gentamicin, allow sufficient peak for efficacy and low trough before re-dosing to reduce nephrotoxicity/ototoxicity (monitor renal function through creatinine clearance)
