C. diff treatment

Question 1

Risk factors for CDI

Answer 1

antimicrobial use (esp clindamycin, penicillin, cephalosporin, fluroquinolones), hospitalization, ages 65-84, IBD, African American, NOT gastric acid suppression

Question 2

Treatment recommendations for CDI

Answer 2

Metronidazole: mild to moderate infection DOC NOT in pregnant or lactating women
Oral vanc: DOC for severe infections and pregnant/lactating women
Pt w/ ileus, abdominal distention, surgical/anatomic abnormalities–> give rectal vanc enema
Complicated infection: give both vanc and metronidazole
1st recurrence- same protocol, 2nd recurrence oral vanc with extended course of treatment

Question 3

Compare the effectiveness of fidaxomicin and vancomyin

Answer 3

ADE are comparable (N/V, abd pain, GI bleed)

Fidazomicin provides superior clinical response and lower incidence of recurrence.

Question 4

Recipient preparation for fecal transplant

Answer 4

stop antibiotics 2-3 days before, colonoscopy like prep to remove stool, loperamine after transplant

Question 5

Donor preparation for fecal transplant

Answer 5

no recent anti-microbial use, screened for fecal pathogens, tested for HBV, HAV, HCV, syphilis, HIV1, HIV2, given milk of magnesia
Instill stool using colonoscopy.
Role and effectiveness: 90% of pt have clinical resolution, may be effective in a a number of conditions