C difficile

Question 1

risk factors for C diff

Answer 1

any antibiotic use in preceding 12 weeks
chemotherapy use
immunocompromised
IBD
hirshprung disease

Question 2

who to do testing for C diff

Answer 2

if risk factors and watery/bloody diarrhea
do not test people who are asymptomatic
less likely to be c diff in children under 5 unless additional risk factors

Question 3

what tests should be used for c diff infection

Answer 3

EIA for toxin
cell cytotoxin assay (expensive)
screening test for GDH in the stool (and then confirmatory test with one of above would be preferred method)

Question 4

if mild c- diff what are symptoms and what is treatment?

Answer 4

mild usually watery diarrhea less than 4 abnormal stools per day and no systemic symptoms

treatment is stop offending abx and reassess in 48 hours

Question 5

if mild did not respond to stopping abx or moderate disease for c diff what is treatment?
how do you classify moderate illness?

Answer 5

moderate is > 4 abnormal stools per day no systemic toxicity

treatment is metronidazole 30 mg/kg/day QID x 10-14 days

Question 6

if initial episode is severe how to classify

how to treat c diff?

Answer 6

severe if evidence of toxicity (high grade fever, rigors, lots of watery/bloody diarrhea)

treat with oral vancomycin 40 mg/kg/day divided QID x 10-14 days

Question 7

if c diff infection severe and complicated?

Answer 7

considered complicated if evidence of systemic toxicty and severe colitis including hypotension, shock, peritonitis, perforation, ileus or megacolon

treatment in this case is 40 mg/kg/day of vancomycin po + IV metronidazole

Question 8

if you have first recurrence of c-diff treatment?

Answer 8

high recurrence risk 15-35%

treat as first episode was treated

Question 9

if you have second + recurrence of c -diff treatment?

Answer 9

treat with taper vancomycin
ex:
40 mg/kg/day QID x 10-14 days, then 10 mg/kg/dose BID x 1 week
Then 10 mg/kg/dose daily x 1 week
then 10 mg/kg/dose every 2-3 days x 2-8 weeks

Question 10

should we use probiotics to treat c diff?

Answer 10

no, no evidence

it is possible they can prevent it but again no evidence