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Clostridium difficile

  • 1.1 Mild to moderate
  • Preferred regimen: Metronidazole 500 mg orally q8h
  • Alternative regimen(If no improvement in 5-7 days): Vancomycin 125 mg orally q6h
  • 1.2 Severe
  • 1.3 Severe complicated
  • Preferred regimen: Vancomycin 500 mg orally q6h AND Metronidazole 500 mg IV q8h
  • NOTE: If ileus present, add Vancomycin 500 mg in 100 mL normal saline per rectum q6h as retention enema
  • 2.Recurrence
  • 2.1 First recurrence
  • preferred regimen: Same as first episode but stratified by severity
  • 2.2 Second recurrence
  • preferred regimen: Vancomycin 125 mg 4 times daily for 14 days or 125 mg 2 times daily for 7 days or 125 mg once daily for 7 days or 125 mg once every 2 days for 8 days (4 doses) or 125 mg once every 3 days for 15 days (5 doses)

Clostridium perfringens

Clostridium tetani

  • 1. General measures Invalid parameter in <ref> tag
  • Preferred regimen: Patients should be placed in a quiet shaded area and protected from tactile and auditory stimulation as much as possible; All wounds should be cleaned and debrided as indicated
  • 2. Immunotherapy
  • Preferred regimen: Human TIG 500 units by intramuscular injection or intravenously as soon as possible AND Age-appropriate TT-containing vaccine, 0.5 cc by intramuscular injection at a separate site
  • NOTE: patients without a history of primary TT vaccination should receive a second dose 1–2 months after the first dose and a third dose 6–12 months later
  • 3. Antibiotic treatment
  • Preferred regimen: Metronidazole 500 mg intravenously or orally every six hours OR Penicillin G 100,000–200,000 IU/kg/day intravenously, given in 2–4 divided doses
  • 4. Muscle spasm control
  • Preferred regimen: Diazepam 5 mg intravenous OR Lorazepam 2 mg titrating to achieve spasm control without excessive sedation and hypoventilation
  • Alternative regimen (1): Magnesium sulphate 5 gm (or 75mg/kg) intravenous loading dose, then 2–3 grams per hour until spasm control is achieved ± Benzodiazepines
  • NOTE: Monitor patellar reflex as areflexia (absence of patellar reflex) occurs at the upper end of the therapeutic range (4mmol/L). If areflexia develops, dose should be decreased
  • Alternative regimen (2): Baclofen OR Dantrolene 1–2 mg/kg intravenous/orally every 4 hours
  • Alternative regimen (3): Barbiturates 100–150 mg every 1–4 hours by any route
  • Alternative regimen (4): Chlorpromazine 50–150 mg by intramuscular injection every 4–8 hours
  • Pediatric regimen: Lorazepam 0.1–0.2 mg/kg every 2–6 hours, titrating upward as needed; Barbiturates 6–10 mg/kg in children by any route; Chlorpromazine 4–12 mg every by intramuscular injection every 4–8 hours
  • NOTE: As for Benzodiazepines, large amounts may be required (up to 600 mg/day); Oral preparations could be used but must be accompanied by careful monitoring to avoid respiratory depression or arrest
  • 5. Autonomic dysfunction control

Mycobacterium abscessus

  • 1.Limited, localized extrapulmonary disease [6]
  • Preferred regimen: Clarithromycin 500 mg PO twice daily ± Amikacin 10-15 mg/kg/day IV or 25 mg/kg three times weekly for 4 months
  • Alternative regimen (1): Amikacin AND Cefoxitin 12 g/day typically for two weeks until clinical improvement in severe cases
  • Alternative regimen (2): Amikacin AND Imipenem 500 mg IV q6-8h for two weeks until clinical improvement in severe cases
  • NOTE: Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed
  • 2.Pulmonary or serious extrapulmonary disease
  • Preferred regimen: Clarithromycin 500 mg PO twice daily AND Amikacin 15 mg/kg/day IV AND Cefoxitin 2g q4h IV OR Imipenem 1g q6h IV for at least 2-4 months, if limited by adverse effects, then switch toClarithromycin 500 mg PO BID or 1000 mg XR OD OR Azithromycin 250 mg PO OD
  • Alternative regimen(1): Tigecycline 100 mg IV load then 50 mg IV q12h could be substituted as one of the injectables
  • Alternative regimen(2): Linezolid 600 mg PO q12h or 600 mg PO OD AND Clarithromycin could replace parental tx if not tolerated or feasible

References

  1. ↑ 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.
  2. ↑ Planche, Tim (2013). "Clostridium difficile". Medicine. 41 (11): 654–657. doi:10.1016/j.mpmed.2013.08.003. ISSN 1357-3039.
  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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
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