PDA

View Full Version : [Infectious Diseases] Updated Treatment Guidelines for C difficile Infection



Janis.Y.Chen
Tue 4th March '14, 10:55am
From http://www.medscape.org/viewarticle/813654?src=cmemp

Antibiotic Recommended in Most Cases

Specific recommendations include the following:

For nonepidemic, nonsevere CDI clearly induced by antibiotic use, with no signs of severe colitis, it may be acceptable to stop the inducing antibiotic and observe the clinical response for 48 hours. However, patients must be monitored very closely and treated immediately for any signs of clinical deterioration.

Antibiotic treatment is recommended for all cases of CDI except for very mild CDI, which is actually triggered by antibiotic use. Suitable antibiotics include metronidazole, vancomycin, and fidaxomicin, a newer antibiotic that can be given by mouth.

For mild to moderate disease, metronidazole is recommended as oral antibiotic treatment of initial CDI (500 mg 3 times daily for 10 days).

Fidaxomicin may be used in all patients with CDI for whom oral antibiotic treatment is appropriate. Specific indications for fidaxomicin may include first-line treatment in patients with first CDI recurrence or at risk for recurrent disease, in patients with multiple recurrences of CDI, and in patients with severe disease and nonsevere CDI.

These recommendations were based on two large phase 3 clinical studies that compared 400 mg/day of oral fidaxomicin with 500 mg/day of oral vancomycin, the standard of care. The rate of CDI recurrence was lower with fidaxomicin, but the cure rate was similar for both treatments.

For severe CDI, suitable oral antibiotic regimens are vancomycin 125 mg 4 times daily (may be increased to 500 mg 4 times daily) for 10 days, or fidaxomicin 200 mg twice daily for 10 days.

In life-threatening CDI, there is no evidence supporting the use of fidaxomicin.

In severe CDI or life-threatening disease, the use of oral metronidazole is strongly discouraged.

For multiple recurrent CDI, fecal transplantation is strongly recommended.

Total abdominal colectomy or diverting loop ileostomy combined with colonic lavage is recommended for CDI with colonic perforation and/or systemic inflammation and deteriorating clinical condition despite antibiotic treatment.

Additional measures for CDI management include discontinuing unnecessary antimicrobial therapy, providing adequate fluid and electrolyte replacement, avoiding antimotility medications, and reviewing proton pump inhibitor use.