E4 GI (C diff) Flashcards
how is C diff transmitted
person to person via fecal-oral route (ew)
2 highlighted C diff risk factors
- PPIs/H2rAs
- chemo
2 highest risk antibiotics for C diff (1 class, 1 drug)
- FQs
- clinda
two primary sxs of C diff
- profuse, watery or green, foul-smelling diarrhea
- abdominal pain
4 additional s/sxs of C diff
- fever
- leukocytosis
- hypoalbuminemia
- AKI
CDI or AAD:
evidence of colitis
CDI
CDI or AAD:
epidemic or endemic pattern
CDI
CDI or AAD:
resolves when antibiotics stopped
AAD
when to test for C diff?
3 or more profuse, watery or mucoid green, foul-smelling shits in 24 hours
3 testing methods for C Diff. which one does IU health use?
- NAAT alone
- Antigen test (GDH) + Toxin A/B test ***
- NAAT + Toxin A/B test
Non-severe C diff:
WBC: ?
SCr: ?
WBC: <15,000/mcL
SCr: <1.5
severe C diff:
WBC: ?
SCr: ?
WBC: >15,000
SCr: >1.5
fulminant C diff:
(3)
- hypotension or shock
- Ileus
- Toxic megacolon **
standard of care C diff tx option
oral vanc
T or F:
Fidaxomicin has a broader spectrum compared to vanc
false, narrower
Has higher rates of sustained response:
A. Oral vanc
B. Fidaxomicin
B
What C diff tx option is no longer recommended first line and is reserved for fulminant cases as an ADDITIONAL agent
metro (iv or po)
1 PK/PD consideration for oral vanc
extremely poor oral bioavailability, but this is good bc we want it at the site of infxn
difference b/w standard and fulminant oral vanc dosing
fulminant is a lot more, still q6h tho
2 PK/PD considerations for fidaxomicin
- protein synthesis inhibitor
- extremely poor oral absorption
1 major downside for fidaxomicin even tho its lowkey the DoC
$4,500 a dose damn
1 PK/PD consideration for metro
excellent oral absorption
metro dosing method for standard vs fulminant
oral for standard
IV for fulminant
Tx options for C diff, initial episode, NON-severe:
(“in order of preference”) (3)
- fidax
- oral vanc
- metro (only if other options arent feasible)
Tx options for C diff, initial episode, SEVERE:
(“in order of preference”) (2)
- fida
- vanc
what random ass drug to avoid with C diff/C diff tx
loperamide
general tx approach with recurrent CDI
change something, either drug or dose
tx options for first CDI RECURRENCE (in order of preference) (4)
- fida x 10 days (if not used initial)
- vanc x 10 days (if not used initial)
- fida x 5 days then x 20 days (extended dosing)
- vanc tapered and pulsed regimen
tx options for second and subsequent CDI RECURRENCE (in order of preference)
same as first but select a different one
tx options for fulminant CDI (in order of preference) (2 with one weird consideration)
- vanc + metro
- IF ILEUS PRESENT -> add vanc enema
Tx duration for fulminant
not well defined (only for fulminant)***
3 risk factors for CDI recurrence
- age >65
- severe CDI on presentation
- immunocompromised host
4 tx options to reduce CDI recurrence
- fecal microbiota transplant
- Rebyota (fecal microbiota suspension)
- Vowst (bacterial spore suspension)
- Bezlotoxumab
FMT is utilized as both a ________ option and _______ to reduce recurrence of CDI
treatment, method
2 potential indications for FMT
- 3 or more episodes of CDI
- poor response to initial therapy for CDI
2 pt considerations for FMT
- requires admin via endoscopy, colonoscopy, or enema
- not available at all hospitals
Rebyota indication (1)
prevention of recurrence of CDI for pts following antibiotic tx for recurrent CDI (2nd line)
how and when do you administer Rebyota?
rectal tube, 24-72 hours after tx is completed*
2 pt considerations for rebyota
- admin via rectal tube
- super expensive
2 Vowst basics
- bacterial spore suspension
- modulate bile acid conc. and restore fatty acids»_space; resistance to C diff colonization and restoration of gut microbiome
indication of Vowst
prevention of recurrence of CDI for pts following antibiotic tx for recurrent CDI
how and when to start Vowst
oral, 2-4 days after tx completion
2 pt considerations for Vowst
- oral
- super expensive
5 AE’s for Vowst
- abdominal distension
- fatigue
- constipation
- chills
- diarrhea
Bezlotoxumab is a mab targeting C diff toxin __ to neutralize its effect
B
Bezlotoxumab indication
prevention of recurrence of CDI for pts at high risk for CDI recurrence
how and when to give bezlotoxumab
IV 1 dose DURING course of CDI tx
2 pt considerations for bezlotoxumab
- caution in pts with CHF*
- also expensive
