diarrhoea Flashcards
which antibiotics are the leading cause of C.diff?
- clindamycin
- cephalosporins
which other drug apart from antibiotics can cause c.diff?
proton pump inhibitors
what are features of C.diff?
diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe toxic megacolon may develop
what does a positive c.diff antigen suggest?
- suggest export to the bacteria rather than a current infection
what is the first line treatment for c.diff?
first-line therapy is oral vancomycin for 10 days
what is second line therapy for c.diff?
oral fidaxomicin
- if reccurrence is within 12 weeks of the first episode
what is third line therapy for c.diff?
oral vancomycin +/- IV metronidazole
what is the management for life threatening c.diff?
oral vancomycin and IV metronidazole
when would you consider a faecal transplant for C.diff?
when ypueve had more than 2 episodes
which conditions predispose to small bowel bacterial overgrowth?
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus
how is small bowel bacterial overgrowth syndrome diagnosed?
- hydrogen breath test
- small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce
- clinicians may sometimes give a course of antibiotics as a diagnostic trial
what is the presentation of small bowel bacterial overgrowth syndrome?
chronic diarrhoea
bloating, flatulence
abdominal pain
what is the management for small bowel bacterial overgrowth syndrome?
- correction of underlying disorder
- antibiotic therapy: rifaximin is now the treatment of choice due to relatively low resistance.
- Co-amoxiclav or metronidazole are also effective in the majority of patients.
how is severity of C.diff categorised?
mild: normal wcc
moderate: 15< wcc
severe: >15 wcc, or creatinine >50% baseline, or temp >38, evidence of colitis radiologically
lifethreatening: hypotension, illeus, toxic megacolon
diagnostic test for C.diff?
CDT (toxin) in stool
