Clostridium difficile infection medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
<font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font><ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 |pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232 }} </ref<ref name="Planche2013">{{cite journal|last1=Planche|first1=Tim|title=Clostridium difficile|journal=Medicine|volume=41|issue=11|year=2013|pages=654–657|issn=13573039|doi=10.1016/j.mpmed.2013.08.003}}</ref><ref name="KnightSurawicz2013">{{cite journal|last1=Knight|first1=Christopher L.|last2=Surawicz|first2=Christina M.|title=Clostridium difficile Infection|journal=Medical Clinics of North America|volume=97|issue=4|year=2013|pages=523–536|issn=00257125|doi=10.1016/j.mcna.2013.02.003}}</ref | <font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font><ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 |pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232 }} </ref><ref name="Planche2013">{{cite journal|last1=Planche|first1=Tim|title=Clostridium difficile|journal=Medicine|volume=41|issue=11|year=2013|pages=654–657|issn=13573039|doi=10.1016/j.mpmed.2013.08.003}}</ref><ref name="KnightSurawicz2013">{{cite journal|last1=Knight|first1=Christopher L.|last2=Surawicz|first2=Christina M.|title=Clostridium difficile Infection|journal=Medical Clinics of North America|volume=97|issue=4|year=2013|pages=523–536|issn=00257125|doi=10.1016/j.mcna.2013.02.003}}</ref><ref name="pmid20307191">{{cite journal|author=Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC et al.| title=Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). |journal=Infect Control Hosp Epidemiol | year= 2010 | volume= 31 | issue= 5 | pages= 431-55 | pmid=20307191 | doi=10.1086/651706 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20307191 }} </ref><ref name="pmid18971494">{{cite journal| author=Kelly CP, LaMont JT| title=Clostridium difficile--more difficult than ever. | journal=N Engl J Med |year= 2008 | volume= 359 | issue= 18 | pages= 1932-40 | pmid=18971494 | doi=10.1056/NEJMra0707500 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18971494 }} </ref> | ||
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Revision as of 20:13, 16 June 2014
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Clostridium difficile Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Clostridium difficile infection medical therapy On the Web |
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American Roentgen Ray Society Images of Clostridium difficile infection medical therapy |
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Risk calculators and risk factors for Clostridium difficile infection medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2]
Overview
Many persons will also be asymptomatic and colonized with Clostridium difficile. Treatment in asymptomatic patients is controversial, also leading into the debate of clinical surveillance and how it intersects with public health policy.
It is possible that mild cases do not need treatment.[1]
Patients should be treated as soon as possible when the diagnosis of Clostridium difficile colitis (CDC) is made to avoid frank sepsis or bowel perforation.
Principles of Therapy for Clostridium difficile infection
- If a patient has a strong pre-test probability for CDI, empiric therapy should be considered regardless of the laboratory testing result.[2] CDI accounts for about 20% of antibiotic-associated diarrhea cases in the USA.[3]The following table contains the main risk factors for CDI:[3][4][5]
| Risk factors for CDI |
|---|
| Antibiotic exposure and the first three months after cessation of antibiotics, most ommonly clindamycin, penicillins, cephalosporins, fluoroquinolones,and multiple antibiotics |
| Exposure to Clostridium difficile: up to 25% of hospitalized patients and residents of lonf term facilities are colonized |
| Age >65 |
| History of inflammatory bowel disease |
- Any antimicrobial agent should be discontinued[2].
- Current guidelines recommend to choose the treatment regimen based on the severity of the disease:[2][3][5][6]
| Severity | Criteria |
|---|---|
| Mild | Diarrhea as the only symptom |
| Moderate | Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline |
| Severe | Leucocytosis >15,000 cells/mL OR serum creatinene level >1.5 times baseline or abdominal tenderness and serum albumin < 3 g/dL |
| Severe complicated | Hypotension or shock, ileus, megacolon, leucocytosis >20,000 cells/mL OR leucopenia <2,000, lactate >2.2 mmol/L, delirium, fever ≥ 38.5 °C, organ failure |
- Duration: recommendations stablish a 10-14 days treatment. If clinical response in 5-7 days, complete 10 days[5].
- Do not use metronidazole beyond the first recurrence episode of CDI or for long-term therapy because of the risk of neurotoxicity[6].
- For mild-to-moderate patients who are intolerant/allergic to metronidazole and for pregnant/breastfeeding women, vancomycin is recommended.[2].
- The use of anti-peristaltic agents to control diarrheaa from confirmed or suspected CDI should be limited or avoided if possible.[2]
- All patients with severe or severe complicated CDI should have supportive care.[2]
- CT scanning of the abdomen and pelvis is recommended in patients with severe complicated CDI.[2]
- All patients with complicated CDI should have an evaluation from the surgery team.[2]
- If there is a third recurrence after a pulsed vancomycin regimen, fecal microbiota transplant should be considered[2].
Medical Therapy
▸ Click on the following categories to expand treatment regimens.[2][3][5][6][7]
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Initial episode
▸ Mild to moderate
▸ Severe
▸ Severe complicated
Recurrence
▸ First recurrence
▸ Second recurrence
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Fecal Bacteriotherapy
Fecal bacteriotherapy, a procedure related to probiotic research, has been suggested as a potential cure for the disease. It involves infusion of bacterial flora acquired from the feces of a healthy donor in an attempt to reverse bacterial imbalance responsible for the recurring nature of the infection. It has a success rate of nearly 95% according to some sources.[8][9][10]
References
- ↑ Nelson R. Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004610. PMID 17636768
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH; et al. (2013). "Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections". Am J Gastroenterol. 108 (4): 478–98, quiz 499. doi:10.1038/ajg.2013.4. PMID 23439232.
- ↑ 3.0 3.1 3.2 3.3 Planche, Tim (2013). "Clostridium difficile". Medicine. 41 (11): 654–657. doi:10.1016/j.mpmed.2013.08.003. ISSN 1357-3039.
- ↑ Hensgens MP, Goorhuis A, Dekkers OM, Kuijper EJ (2012). "Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics". J Antimicrob Chemother. 67 (3): 742–8. doi:10.1093/jac/dkr508. PMID 22146873.
- ↑ 5.0 5.1 5.2 5.3 Knight, Christopher L.; Surawicz, Christina M. (2013). "Clostridium difficile Infection". Medical Clinics of North America. 97 (4): 523–536. doi:10.1016/j.mcna.2013.02.003. ISSN 0025-7125.
- ↑ 6.0 6.1 6.2 Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC; et al. (2010). "Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA)". Infect Control Hosp Epidemiol. 31 (5): 431–55. doi:10.1086/651706. PMID 20307191.
- ↑ Kelly CP, LaMont JT (2008). "Clostridium difficile--more difficult than ever". N Engl J Med. 359 (18): 1932–40. doi:10.1056/NEJMra0707500. PMID 18971494.
- ↑ Schwan A, Sjölin S, Trottestam U, Aronsson B (1983). "Relapsing clostridium difficile enterocolitis cured by rectal infusion of homologous faeces". Lancet. 2 (8354): 845. PMID 6137662.
- ↑ Paterson D, Iredell J, Whitby M (1994). "Putting back the bugs: bacterial treatment relieves chronic diarrhoea". Med J Aust. 160 (4): 232–3. PMID 8309401.
- ↑ Borody T (2000). ""Flora Power"-- fecal bacteria cure chronic C. difficile diarrhea" (PDF). Am J Gastroenterol. 95 (11): 3028–9. PMID 11095314.