Sweatman Tx of C diff Flashcards
tx options for C diff infection
metronidazole
vancomycin
fidaxomicin-DIFICID
fecal transplant
particularly virulent strain of C dif
NAP-1/O27
why is NAP-1/O27 so virulent
lacks protein known as tcdC-expression of this protein NORMALLY negatively regulates transcription and therfore production fo the toxin-this strain makes MUUUCH more toxin=more virulent
most common nsoscomial infection in the US
C diff
7 x more deadly than all other GI infections combined
risk factors for CDI
clinda penicillins cephalosporins floroquinolones Longer term hospital setting AGE (65-85) IBD black race increased comborbities PPI??-but not really
dx of CDI
diarrhea following recent Ab use
-toxinogenic Cdiff or A/B toxins in the stool
confirmation of infection by
EIA-detects A and B toxins
*limited sensitivity-frequently false negative
tx regimens for Cdif
> 1st metronidazole PO
or
vanc PO-less commonly used
THEN> higher dose vanc PO- IV metronidazole
if obstruciuton or prevention of drug from reaching colon
rectal VANC enemas
do not use metronidazole under what circumstances
pregnant patient-crosses placenta and in in breast milk==> causes facial anomalaies
high doses and prolonges metronidazole use…
peripheral neuropathy- numbness and paresthesias
treat 1st reoccurance of CDI with
same regimen as the first time
-
treat 2nd recurrence with
ORAL VANCOMYCIN in and EXTENDED TREATMENT COURSE
macrolide Ab useful against CDI and some hyperviorulent strains
DIFICID-fidaxomicin
why is fidaxomicin useful
no activity agaisnt GH anerobes, facultative anerobes and enterobactiaceae
- limited affect on normal fecal flora
- no cross resistance with other Ab’s
- minimal systematization after oral dosin
- no more side effecst than Vancomycin
