C. Diff Flashcards
What is the clinical definition of CDAD?
diarrhea > 3 unformed stools per 24h for > 2 days with no other recognized cause
and detection of toxin A or B in the stool or toxin producing C. difficile in the stool
or visualization of pseudomembranes in the colon via colonoscopy
What are the symptoms of c. diff?
diarrhea
fever
abdominal pain
leukocytosis
List the three step of pathogenesis for C. diff
Step 1 – exposure to antimicrobial agents establishes susceptibility to CDI through disruption of normal colonic microbiota
Step 2 - exposure to toxigenic Clostridioides difficile
Step 3 – virulent strain or high risk antibiotic or inadequate host immune response
Traits of C. diff organism
gram positive
sport forming
anaerobic bacillus
causes toxin mediated disease - two toxins - A & B
Which antibiotics have the highest risk to cause CDI?
clindamycin
fluoroquinolones
cephalosporins (especially 3rd and 4th)
ampicillin
carbapenems
What antibiotics has a low risk of causing C. diff
penicillin
macrolides
tetracycline
TMP/SMX
aminoglycosides
List some risk factors for C. diff
older age
greater severity of underlying illness
gastrointestinal surgery
use of rectal electronic thermometers
enteral tube feeding
antacid therapy (PPI > H2 antagonists)
hospitalization - linked to # of days
List some management strategies for C. diff
stop the offending antibiotics - if possible
fluid and electrolyte replacement therapy
avoid drugs which inhibit peristalsis (loperamide)
What are some factors that help definition moderate/mild vs severe
severe includes
Leukocytes > 15,000 cell/ul
SCr > 1.5 baseline
What are some factors that help define uncomplicated vs complicated
hypotension
shock
ileus or megacolon
What is first line initial episode mild to moderate c. diff?
vancomycin 125 mg PO QID f10-14d
Alternative first line initial episode mild to moderate c. diff
fidaxomicin 200 mg PO BID f10d
metronidazole 500 mg PO TID f10-14d
C diff with initial episode - severe uncomplicated (hypoalbuminemia)
vancomycin 125 mg po qid f10-14d
fidaxomicin 200 mg po bid f10d
C diff Initial episode - severe complicated
vancomycin 125-500 mg po qid f10-14d
or via NG tube in conjunction with metro 500 mg IV q8h
vancomycin retention enema sometimes added if ileus
c diff initial episode severe complicated but alternative
fidaxomicin 200 mg po bid f10d with IV metronidazole if severe allergy to po vancomycin
Management with Pediatrics for C. diff
same principles of tx
- stop antibiotics
- supportive care - fluids, antipyretics, nutrition
- specific tx for pathogen if no improvement after d/c antibiotics
List the monitoring parameters for C. diff tx
resolution of diarrhea
resolution of fever, abdominal pain, other sx the pt has
check for antimotility agents
WBC, electrolytes
adherence with therapy - especially complex tapering regimen
adverse effects of drug - agent dependent
List some ways for prevention of spread
handwashing with soap and water rather than alcohol gel
gloves and gowns
isolation / separate room and equipment
adequate room cleaning
How can pharmacists prevent c. diff
practicing good hygienic practices
deprescribing unnecessary PPIs
avoid anti-motility agents if possible
avoid unnecessary antibiotic use overall
don’t treat asymptomatic c. diff
support narrow spectrum prescribing for other infections
Pediatrics mild to moderate initial episode (just medication not dose)
metronidazole
vancomycin
Pediatrics severe uncomplicated initial episode (just medication not dose)
vancomycin
Pediatrics severe complicated initial episode (just medication not dose)
vancomycin
Pediatrics first recurrence mild to moderate (just medication not dose)
metronidazole
vancomycin
Pediatrics first recurrence severe uncomplicated (just medication not dose)
vancomycin
Pediatrics second or subsequent recurrences (just medication not dose)
vancomycin
or fecal microbiota
First recurrence C. diff tx
same as initial episode
same dose for both vancomycin or fidaxomicin
Second recurrences C. Diff
prolonged vancomycin
fecal microbiota transplantation
monoclonal antibody
surgery
