Pharm C. diff treatment

Question 1

What is the toxin produced by C diff NAP-1/027?

Answer 1

lacks tcdC - expression normally negatively regulates regulates transcription and therefore production of the toxin. Toxins A & B go up.

Question 2

How bad is C diff epidemiologically?

Answer 2

7x all other GI infections combined

Question 3

What strain of C diff is linked to increased disease severity & mortality?

Answer 3

NAP1 Ribotype 027

Question 4

antimicrobial combinations that can bring on c diff infection? (2 sets of 2)

Answer 4

clindamycin - penicillins

cephalosporins - fluoroquinalones

Question 5

Risk factors for c diff infection? (5)

Answer 5

exposure to antimicrobial combinations/mult
hospitalization
age (65-84)
IBD
Gastric acid suppression

Question 6

Are PPIs a risk factor for C diff?

Answer 6

no

Question 7

C diff dx

Answer 7

clinical suspicion, immunoassays to toxins A & B

Question 8

DOC for C diff

Answer 8

oral metronidazole for mild or moderate
oral vanc for severe or pregnant/lacating
high dose vanc oral or IV for complicated
Rectal vanc for ileus, abd distention

Question 9

why shouldn’t metronidazole be used in preg/lact?

Answer 9

crosses placenta, expressed in milk. unknown effects.

Question 10

fidaxomicin [DIFICID]

Answer 10

novel mechanism of bacterial RNA polymerase inhibitor. lack of cross-resistance. Remains in GI tract. Adverse GI events comparable to vanc

provides less recurrence than vanc therapy, but very expensive. Useful if recurrence costs would overcome drug cost.

Question 11

is it good to put poop from one person into another?

Answer 11

Yep, seems so.