Antibiotic Associated Colitis (AAC)

Question 1

Greatest incidence of C. difficile is in what age group?

Answer 1

65+yo

Question 2

FREQUENT causes of AAC (4)

Answer 2

1. Fluoroquinolones, i.e. levofloxacin
2. Clindamycin
3. Broad Spectrum penicillin - piperacillin/tazobactam
4. Broad spectrum cephalosporin - cefriaxone

Question 3

OCCASIONAL causes of AAC (2)

Answer 3

1. Macrolides, i.e. erythro/azithro/clarithro-(mycin)

2. TMP-SMX

Question 4

SELDOM causes of AAC (5)

Answer 4

1. Aminoglycoside, i.e. gentamicin
2. TCN, i.e. doxycycline
3. Chloramphenicol
4. Matronidazole
5. Vancomycin

Question 5

C. difficile treatment failure % and Recurrence % in Metronidazole v. vancomycin

Answer 5

Metronidazole = 13.2% failure, 20.2% recurrence
Vancomycin = 3.4% failure, 18.4% recurrence

Question 6

Does mild C. diff infection respond better to metronidazole or vancomycin? How about severe C. diff infection?

Answer 6

Mild - about the same (vanc 98% response rate v. Metro 90% response rate)
Severe - Vanc 97% response rate v. Metro 76% response

Question 7

What kills C. diff?

Answer 7

SOAP AND WATER. Alcohol does not kill spores.

Question 8

While uncommon, ___ infection is most likely to be seen in CF patients or people with Foley caths.

Answer 8

Burkholderia cepacia

Question 9

**Treatment of AAC - three treatments and which is used for mild to moderate v. severe/failure

Answer 9

1. Mild to Moderate use Metronidazole
2. seVere use Vancomycin
3. Fidaxomycin - seldom, Expensive ($5011)

Question 10

MOA of metronidazole

Answer 10

Disrupts DNA’s helical structure

Question 11

Absorption of metronidazole

Answer 11

Oral, IV, intravaginal, topical

Question 12

Fate of metronidazole

Answer 12

Most body fluids, including CNS (when given IV)

Question 13

Adverse reactions of metronidazole (6)

Answer 13

1. N/V
2. Xerostomia (dry mouth)
3. Metallic taste
4. Anorexia
5. Abdominal pain
6. Neurologic

Question 14

Drug interactions with metronidazole (2)

Answer 14

1. ALCOHOL results in disulfiram-like reaction (palpitations, etc), N/V
2. Causes increased WARFARIN levels, increased INR, and bleeding

Question 15

Bacterial treated with metronidazole (5)

Answer 15

Bacteroides fragilis, CLOSTRIDIUM DIFFICILE, C. perfrigens, Gardneralla vaginalis, Helicobacter pylori

Question 16

Protozoa treated with metronidazole (3)

Answer 16

Entamoeba histolytica, Giardia lamblia, Trichomonas vaginalis

Question 17

Worms treated with metronidazole

Answer 17

None

Question 18

Recommendations for metronidazole and pregnancy

Answer 18

Not recommended, especially during 1st trimester

Question 19

Recommendations for metronidazole and breast feeding

Answer 19

Not recommended, but if needed can resume nursing 12-24 hrs after a single dose

Question 20

MOA of vancomycin

Answer 20

• Inhibits cell wall synthesis and cystoplasmic membrane destruction
  BacteriCIDAL, SLOW

Question 21

Absorption of metronidazole

Answer 21

Orally for C. dif
IV renal (check peak/trough) ?????

Question 22

Adverse reactions of vaNcOmycin (3)

Answer 22

Nephrotoxic, Ototoxic, red-neck/blushing from nipple-line up.

Question 23

Three drug interactions iwth vancomycin

Answer 23

Amphotericin
Gentamycin (any aminoglycoside)
Loops (furosemide)

Question 24

Name of procedure that puts healthy donor’smicrobiota into recipient’s GI tract to restore bacterial balance.

Answer 24

Fecal Microbiota Transplant (FMT) - normally a donor who is a relative.
Only recommended for SERIOUS cases

Question 25

Administration of Fecal Microbiota Transplant (4 ways)

Answer 25

1. Enema
2. Colonoscope (to entire colon)
3. Naso-gastric tube (pretreat with PPI to preent acid from killing bacteria
4. Naso-jejunum tube (bypassing the acid, getting all of the lower GI)