Treatment of C. difficile Flashcards
What are the treatment options for C. difficile infections?
Metronidazole
Vancomycin
Fidaxomicin
Fecal microbiota transplantation
What are the risk factors for C. difficile infections?
Hospitalization
Age 65-84
IBD
Gastric acid suppression?
What are the current treatment recommendations for C. difficile infections?
Metronidazole: q8h x 10d (DOC for mild-moderate)
Vancomycin: q6h x 10d (severe dz, pregnant/lactating)
High dose Vancomycin: q6h x 10d (DOC for complicated dz along with IV metronidazole)
Rectal Vancomycin: Used when oral antibiotics cannot reach colon
Compare the effectiveness of fidaxomicin and vancomycin in treating patients at high risk of CDI recurrance?
Head to head Fidaxomicin is more effective than vancomycin
Discuss the role and effectiveness of fecal microbiota transplantation in the treatment of C. difficle infection?
Fecal transplant has been shown to be about 89% effective in treating C. diff infections.
What makes the NAP-1/027 strain of C. difficile more virulent?
NAP-1/027 lacks a protein known as tcdC whose expression normally negatively regulates transcription of Toxin A and Toxin B. Altogether this results in overproduction of toxin.
What are the important epidemiological facts associated with C. difficile infection?
- C. difficile is the leading cause of antibiotic induced diarrhea
- Most common nosocomial infection
- Mortality from CD is 7 times greater than all other intestinal infections combined.
Which specific anti-microbials are risk factors for C. difficile infection?
Clindamycin
Cephalosporins
Penicillins
Flouroquinolones
What factors increase the risk of CDI recurrance?
Increased age
Black race
comorbidities
NOT PPIs
How is CDI diagnosed?
Diarrhea in pt with recent abx use.
Rapid immunoassay to toxin A and B (EIAs)
In what population should the use of metronidazole be avoided?
Metronidazole should not be used in the pregnant or lactating because it readily crosses the placenta and is expressed in breast milk.
What adverse effects are associated with metronidazole?
Peripheral neuropathy (numbness/parathesias)
What is the MOA of Fidaxomicin?
Macrolide anti-biotic (bactericidal against C. diff)
Inhibits Bacterial RNA polymerase
Not effective against garm negatives, facultative aerobes, and normal flora.
What pharmacologic properties make fidaxomicin an effective drug?
No cross resistance with other antimicrobials
Minimal systematization after oral administration
What are the adverse effects of Vancomycin?
Similar to vancomycin:
Nausea/vomiting
Abd pain
GI bleed
