Treatment of Clostridium difficile Infections

Question 1

C. diff produces two toxins that are responsible for

Answer 1

pathogenesis.

Question 2

C. diff Toxins are

Answer 2

Toxin A & Toxin B. NAP-­‐1/027 is a very virulent strain that lacks tcdC (which normally decrease toxin production) leading to increase toxin production.

Question 3

C. diff is the #1 cause of

Answer 3

antibiotic induced diarrhea, #1 hospital acquired infxn, #1 mortality of intestinal infxn (7x increase than all other intestinal infxn combined). Increase Severity & Mortality due to NAP-­‐1/027

Question 4

C. diff Risk Factors:

Answer 4

Antibiotic use (especially combinations w/ Clindamycin, Penicillin, Cephalosporins, Fluroquinolones), Hospitalization, Increase Age, & IBD. PPI use is NOT a riskfactor. C diff recurs more often w/ Increase Age, & AAs

Question 5

C. diff Diagnosis:

Answer 5

Clinical suspicion, presence of risk factors, Immuno-­‐assays (for toxinA/B)

Question 6

C. diff Tx:

Answer 6

Newer drugs are increase $ but C diff is a very expensive dz in the US (5billion/yr
o Metronidazole:
o Vancomycin:
o Fidaxomicin:

Question 7

Metronidazole:

Answer 7

$ DOC for mild dz, Nausea, Metallic taste, Per. Neuropathy, Not for pregnancy (Crosses placenta/breast milk).

Question 8

Vancomycin:

Answer 8

$$ DOC for severe/recurrent/ pregnant dz. Can be given rectally if needed.

Question 9

Fidaxomicin:

Answer 9

$$$ Macrolide, Inhs RNA polymerase, limited effect on normal flora or G-­negative in GI tract, No cross resistance w/ other antimicrobials, minimal systemization (stool elimination), GI AEs (similar to vanc). Better than Vanc!

Question 10

Fecal Transplant:

Answer 10

Putting someone’s poop in someone else’s colon… The donor gets loperamide to keep the donor poop up there for a while. Clinical trial showed it to be pretty efficacious (especially when done in lower GI). No AEs.

Question 11

Meropenem:

Answer 11

is an ultra-broad spectrum injectable antibiotic. It is a beta-lactam & belongs to the subgroup of carbapenem:

Question 12

Meropenem: Adverse effects.

Answer 12

One study showed Clostridium difficile associated diarrhea (CDAD) happened in 3.6% of the patients on meropenem.

Question 13

Cefprozil:

Answer 13

is a semi-synthetic broad-spectrum cephalosporin antibiotic.

Question 14

Cefprozil: Adverse Effects.

Answer 14

Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Cefzil, and may range in severity from mild diarrhea to fatal colitis.
Hypersensitivity rxn it penicillin synsative.