Impact of Revised Infectious Diseases Society of America and Society for Healthcare Epidemiology of America Clinical Practice Guidelines on the Treatment of Clostridium difficile Infections in the United States

2020 ◽  
Author(s):  
Cornelius J Clancy ◽  
Deanna Buehrle ◽  
Michelle Vu ◽  
Marilyn M Wagener ◽  
M Hong Nguyen
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Clostridium Difficile ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Day Treatment ◽  
The United States ◽  
Prescription Data ◽  
Oral Vancomycin ◽  
Oral Metronidazole

Abstract Background Our objective was to determine if oral vancomycin, fidaxomicin, and oral metronidazole use in the United States changed after publication of revised clinical practice guidelines for Clostridium difficile infection (CDI) in February 2018. Methods We obtained US antibiotic prescription data (IQVIA) from 2006–August 2019 and used guideline-recommended dosing regimens to estimate monthly numbers of 10-day treatment courses of vancomycin, fidaxomicin and metronidazole. Interrupted time-series analyses were performed, adjusted by month. We compared linear trends for monthly numbers of treatment courses in different time periods. Results Cumulative treatment courses of oral vancomycin and fidaxomicin increased by 54% (n = 226 166) and 48% (n = 18 518), respectively, in 18 months following guidelines compared with 18 months before; those of oral metronidazole decreased by 3% (n = 238 372). Monthly vancomycin and fidaxomicin use significantly increased throughout the period following revised guidelines (P < .0001 and P = .0002, respectively), whereas that of metronidazole decreased significantly (P < .0001). Monthly vancomycin use increased and metronidazole use decreased to a significantly greater extent after publication of revised guidelines than after publication of clinical trials establishing superiority of vancomycin over metronidazole (P < .0001). Conclusions Revised practice guidelines have had a significant impact on CDI treatment in the US. Clinical trial data used for the revised guidelines were available since 2007–2014 and 2011–2012 for oral vancomycin and fidaxomicin, respectively. Guidelines or guidance documents for treating CDI and other infections should be updated in more timely fashion.

Gastric Cancer Clinical Practice Guidelines in Oncology

2003 ◽  
Vol 1 (1) ◽  
pp. 28 ◽  
Keyword(s):  
United States ◽  
Gastric Cancer ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
The United States ◽  
Major Health Problem ◽  
Major Health ◽  
Recent Version ◽  
Upper Gastrointestinal

Carcinomas originating in the upper gastrointestinal tract constitute a major health problem around the world. In fact, experts estimate that approximately 34,700 new cases of upper gastrointestinal carcinomas and 25,000 deaths will have occurred in the United States in 2002. This article summarizes the NCCN clinical practice guidelines for managing gastric cancer, which portray uniformity in the systemic approach to cancer in the United States. The article also discusses anticipated future advances in the treatment of gastric carcinoma. For the most recent version of the guidelines, please visit NCCN.org

scholarly journals Utilization of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative electronic mailing list (listserv) by healthcare professionals

2020 ◽  
pp. 1-3
Author(s):  
Christopher C. McPherson ◽  
Zachary A. Vesoulis ◽  
Talene A. Metjian ◽  
Mirela Grabic ◽  
Summer Reyes ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Retrospective Study ◽  
Clinical Practice Guidelines ◽  
Antimicrobial Stewardship ◽  
Practice Guidelines ◽  
Healthcare Professionals ◽  
The United States ◽  
Mailing List

Abstract Optimizing pediatric antimicrobial stewardship is challenging. In this retrospective study, we evaluated 515 original e-mails to 482 members of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative electronic mailing list ([email protected]). The plurality of threads discussed clinical practice guidelines, and pharmacists were most likely to initiate and respond. Representation was geographically diverse within and outside the United States.

Breast Cancer Clinical Practice Guidelines in Oncology

2003 ◽  
Vol 1 (2) ◽  
pp. 148 ◽  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Invasive Breast Cancer ◽  
The United States ◽  
Cancer Society ◽  
Nccn Guidelines ◽  
Recent Version

The American Cancer Society estimates that approximately 205,000 new cases of breast cancer were diagnosed in the United States in the year 2002, and approximately 40,000 patients will die of this disease. The NCCN guidelines discuss the complex and varied therapeutic options for patients with noninvasive or invasive breast cancer. For the most recent version of the guidelines, please visit NCCN.org

Hepatobiliary Cancer Clinical Practice Guidelines in Oncology

2003 ◽  
Vol 1 (1) ◽  
pp. 94 ◽  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Gallbladder Cancer ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
The United States ◽  
Newly Diagnosed ◽  
Nccn Guidelines ◽  
Hepatobiliary Cancer ◽  
Recent Version

Hepatobiliary cancers are both common and highly lethal worldwide. However, in the United States, the incidence of hepatobiliary cancer is relatively low, with approximately 23,700 patients newly diagnosed each year. Gallbladder cancer is the most common of the hepatobiliary malignancies, accounting for approximately 30% of newly diagnosed cases in the United States. Along with summaries of the NCCN guidelines for the 4 subtypes of hepatobiliary cancer, this article includes a brief discussion of the epidemiology, pathology, etiology, staging, diagnosis, and treatment of each subtype. For the most recent version of the guidelines, please visit NCCN.org

scholarly journals 779. Impact of updated IDSA practice guidelines on the treatment of Clostridium difficile infections in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S346-S346 ◽  
Author(s):  
Cornelius J Clancy ◽  
Minh-Hong Nguyen
Keyword(s):  
United States ◽  
Practice Guidelines ◽  
Randomized Clinical Trials ◽  
The United States ◽  
Prescription Data ◽  
Recommended Treatment ◽  
The Us ◽  
Before And After ◽  
Dosing Regimens ◽  
National Pact

Abstract Background IDSA published updated practice guidelines for C. difficile infections (CDI) in February 2018. Since publication of previous CDI guidelines in2010, randomized clinical trials (RCTs) have demonstrated benefit of oral (po) vancomycin or fidaxomicin over metronidazole in at least some types of CDI. Updated guidelines endorsed vancomycin or fidaxomicin as recommended treatment for initial and recurrent nonfulminant CDI episodes, and vancomycin as treatment for fulminant CDI. We studied the use of po vancomycin, fidaxomicin and metronidazole in the United States before and after publication of updated guidelines. Methods We obtained US antibiotic prescription data (IQVIA, Durham, NC) since 2013, and used standard dosing regimens for treatment of initial CDI to estimate numbers of infections treated with different agents. Po vancomycin and fidaxomicin are used exclusively against known or suspected CDI. Metronidazole is used to treat CDI and other infections. IQVIA data do not capture indications for prescriptions. Results Treatment courses of po vancomycin and fidaxomicin increased by 45% (n = 126,729 increase) and 44% (n = 11,243 increase), respectively, over the 12 months after publication of the updated CDI guidelines compared with 12 months before publication (Figure, second arrow; Table). Increased use of both agents was evident in the first month after guidelines were published. Over the same 12 month periods, treatment courses of po metronidazole decreased by 3% (190,430 decrease). In comparison, treatment courses of po vancomycin increased by 24% (n = 47,219 increase) over the 12 months after publication of the multi-national PACT study in August 2014 (Figure, first arrow), which demonstrated superiority of vancomycin over metronidazole. Since 2013, there were no significant increases in the use of fidaxomicin until publication of the updated guidelines. Conclusion Updated IDSA guidelines have had a major impact on treatment of CDI in the US. RCT data used for guideline updates have been available since 2007–14 and 2011–12 for po vancomycin and fidaxomicin, respectively. IDSA should provide more timely updates to practice guidelines as new data emerge. Annual or bi-annual updates posted in electronic or other nontraditional formats may be more efficient than publishing long-form articles. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document