Clostridium difficile—Associated Diarrhea, an Emerging Epidemic: Therapeutic Options

2007 ◽  
Vol 20 (4) ◽  
pp. 347-353
Author(s):  
Christopher R. Emerson
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admissions ◽  
Treatment Options ◽  
Infectious Diarrhea ◽  
First Line ◽  
Oral Vancomycin ◽  
Considerable Morbidity ◽  
Clostridium Difficile Associated Diarrhea ◽  
Pharmacologic Agents ◽  
Oral Metronidazole

Clostridum difficile—associated disease (CDAD) is the leading cause of infectious diarrhea and is associated with considerable morbidity and mortality. The incidence is estimated to range from 3.4 to 8.4 cases per 1000 hospital admissions, and it has become a growing problem at many institutions. Treatment options for CDAD are limited due to a paucity of new pharmacologic agents and studies examining other potential treatments. Historically oral metronidazole and oral vancomycin have been used as first-line agents in the treating CDAD, however recent reports of treatment failure and recurrence with these agents have surfaced. These reports illustrate a need for novel pharmacologic agents and a thorough review of currently available agents that may have activity against C difficile. Available data on the treatment of CDAD were extracted and reviewed to outline the appropriate management of CDAD.

Increase in Use of Vancomycin for Clostridium difficile Infection in US Hospitals

2010 ◽  
Vol 31 (8) ◽  
pp. 867-868 ◽  
Author(s):  
Amy L. Pakyz ◽  
Norman V. Carroll ◽  
Spencer E. Harpe ◽  
Michael Oinonen ◽  
Ronald E. Polk
Keyword(s):  
Clostridium Difficile ◽  
Primary Treatment ◽  
Epidemic Strain ◽  
First Line ◽  
Oral Vancomycin ◽  
Treatment Practices ◽  
First Line Therapy ◽  
Life Threatening ◽  
Vancomycin Resistant ◽  
Serious Disease

Clostridium difficile infection (CDI) is a potentially serious disease for which the epidemiology has recently changed, because of an emerging drug-resistant strain of the pathogen. Metronidazole and oral vancomycin are the primary treatment agents.2 Metronidazole has been historically favored as the first-line agent, partly to reduce the selection pressure for vancomycin-resistant enterococci (VRE), although metronidazole can also select for VRE. Vancomycin was traditionally reserved for metronidazole treatment failure or life-threatening disease. In a study conducted before emergence of the epidemic strain, vancomycin was reported to be superior for the initial treatment of severe CDI and for treatment of CDI that does not respond to metronidazole. Expert opinion calling for the use of vancomycin as first-line therapy, especially for severe CDI emergence of the epidemic strain, and reports of decreased metronidazole efficacy may have impacted CDI treatment practices. The purpose of this study was to characterize trends in CDI treatment in US hospitals.

scholarly journals Struggling with recurrent Clostridium difficile infections: is donor faeces the solution?

2009 ◽  
Vol 14 (34) ◽  
Author(s):  
E van Nood ◽  
P Speelman ◽  
E J Kuijper ◽  
J J Keller
Keyword(s):  
Clostridium Difficile ◽  
Case Reports ◽  
Treatment Options ◽  
Intestinal Flora ◽  
Treatment Strategies ◽  
Case Series ◽  
Oral Vancomycin ◽  
Vancomycin Therapy ◽  
Evidence Based Treatment

Patients with recurrent Clostridium difficile infections (CDI) in hospitals and the community constitute an increasing treatment problem. While most patients with a first infection respond to either metronidazole or oral vancomycin, therapy in recurrent C. difficile infections tends to fail repeatedly. Lack of alternative treatment options can be a tremendous burden, both to patients and their treating physicians. Most guidelines recommend prolonged oral vancomycin pulse and or tapering schedules, but evidence-based treatment strategies are lacking. The role of immunoglobulins, whey prepared from vaccinated cows, probiotics or other antibiotics is unclear. Since 1958 several case series and case reports describe a treatment strategy where faecal infusions are successfully given for the treatment of recurrent CDI. Restoring intestinal flora has been historically thought of as the mechanism responsible for cure in these patients. In the literature, more than 150 patients have received faeces from a healthy donor, either infused through an enema, or through a nasoduodenal or nasogastric tube. We summarise the literature regarding treatment with donor faeces for recurrent CDI, and introduce the FECAL trial, currently open for inclusion.

scholarly journals Clostridium difficile: How Much do Hospital Staff Know About it?

2009 ◽  
Vol 91 (6) ◽  
pp. 464-469 ◽  
Author(s):  
Somaiah Aroori ◽  
Natalie Blencowe ◽  
Geoff Pye ◽  
Reuben West
Keyword(s):  
Clostridium Difficile ◽  
Nursing Staff ◽  
Healthcare Professionals ◽  
Control Measure ◽  
Infection Control Measure ◽  
Hospital Staff ◽  
Oral Vancomycin ◽  
Drug Of Choice ◽  
Healthcare Professions ◽  
Oral Metronidazole

INTRODUCTION The aim of this study was to determine the awareness of Clostridium difficile infection amongst healthcare professionals. SUBJECTS AND METHODS A total of 132 healthcare professionals (18 consultants, 40 trainee doctors, and 74 nursing staff) in our hospital were randomly surveyed using a questionnaire consisting of 17 questions covering various aspects of C. difficile. RESULTS More than 50% of healthcare professionals correctly identified C. difficile as an anaerobic bacillus. Half of the consultants and one-third of the trainees and nurses were aware that 5% of adults carry C. difficile in the gut. Overall, 80% of doctors and 40% of nursing staff (P = 0.001) were aware of the spectrum of illnesses caused by C. difficile. Seven (39%) consultants, 25 (63%) trainees, and 26 (37%) nurses correctly identified the various predisposing factors for the acquisition of C. difficile infection. Only one-third of doctors and 8% of nursing staff were aware that antibiotic restriction was the single most effective C. difficile infection control measure. In addition, 40% of doctors and 8% of nursing staff were aware that cytotoxin assay is the gold standard diagnostic test. Less than 30% of healthcare professionals were aware of the differences between the most common strain and the strain of C. difficile responsible for recent outbreaks. Only 6 (33%) consultants, 21 (53%) trainees (P = not significant), and 28 (38%) nursing staff were aware that hand washing with soap and water is the most effective way of preventing transmission of C. difficile infection. Results showed that 93% of trainees, 78% of consultants (P = 0.05) and 70% of nurses correctly answered that oral metronidazole is the drug of choice for the treatment of C. difficile infection. Compared to 73% of trainees, only two (11%) consultants (P < 0.0001) and 20 (27%) nursing staff correctly stated that oral vancomycin is the second-line treatment for persistent symptomatic C. difficile infection. CONCLUSIONS There is a significant lack of knowledge concerning C. difficile infection amongst healthcare professions, in particular amongst consultants and nurses in our hospital.

scholarly journals Impact of an automatic hospital probiotic protocol on Clostridioides (Clostridium) difficile infection (CDI) rates and CDI antibiotic usage in a community hospital setting

2019 ◽  
Vol 21 (2) ◽  
pp. 72-75
Author(s):  
Douglas Slain ◽  
Amy Georgulis ◽  
Ron Dermitt ◽  
Laura Morris ◽  
Stephen M Colodny
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Community Hospital ◽  
Hospital Setting ◽  
Saccharomyces Boulardii ◽  
Antibiotic Usage ◽  
Oral Vancomycin ◽  
Hospitalised Patients ◽  
Oral Metronidazole

The aim of the present study was to see how widespread preventative use of the probiotic Saccharomyces boulardii via automatic protocol in hospitalised patients receiving antibacterials affected rates of hospital-associated Clostridioides ( Clostridium) difficile infection (HA-CDI). Rates of HA-CDI appeared to be similar between the pre-protocol and protocol periods. Use of CDI treatment antibiotics (oral metronidazole and oral vancomycin) was also similar. Laboratory-confirmed isolation of S. boulardii from sterile body sites was identified in five patients during the protocol versus only one case in the pre-protocol years.

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 &lt; .0001 and P = .0002, respectively), whereas that of metronidazole decreased significantly (P &lt; .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 &lt; .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.

scholarly journals Fidaxomicin Compared With Oral Vancomycin for the Treatment of Severe Clostridium difficile–Associated Diarrhea: A Retrospective Review

2019 ◽  
Vol 55 (4) ◽  
pp. 268-272
Author(s):  
Bryant B. Summers ◽  
Mary Yates ◽  
Kerry O. Cleveland ◽  
Michael S. Gelfand ◽  
Justin Usery
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Recurrence Time ◽  
Financial Benefit ◽  
Oral Vancomycin ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Clostridium Difficile Associated Diarrhea

Purpose: The most recent published guidelines on Clostridium difficile–associated diarrhea (CDAD) developed by the Infectious Diseases Society of America (IDSA) were released in 2017 and outline its treatment based on severity of the disease and recurrence; however, a clear first-line agent has not been recommended specifically for severe CDAD. Methods: This retrospective chart review was approved by the institutional review board and consisted of three community hospitals and one academic medical center. To be included, patients need to meet criteria for severe CDAD and receive at least 72 hours of therapy. Patients received either oral vancomycin or fidaxomicin, in addition to other therapies for CDAD, and differences in outcomes such as cost obtained from a common charge center, rates of recurrence, time to recurrence as measured at time of positive to negative polymerase chain reaction (PCR) test, and mortality were assessed. Results: Of the 147 patients, 74 patients received fidaxomicin and 73 patients received oral vancomycin. The average hospitalization cost for patients receiving fidaxomicin was $129,338.69 and for patients receiving vancomycin was $153,563.81 ( P = .26). Recurrence rates were lower with fidaxomicin compared with vancomycin (6.8% vs 17.6%; P = .047), and time to recurrence was longer with fidaxomicin versus vancomycin, but not statistically significant (96.8 ± 45.9 days vs 63.2 ± 66.9 days; P = .321). Mortality, length of stay in the intensive care unit, and overall length of stay were similar between the two therapies. Conclusions: In the treatment of severe CDAD, recurrence rates were lower and time to recurrence was higher with fidaxomicin compared with oral vancomycin. A clear financial benefit has yet to translate from these known findings.

Treatment options for sundowning in patients with dementia

2014 ◽  
Vol 4 (4) ◽  
pp. 189-195
Author(s):  
Joseph Blais ◽  
Monica Zolezzi ◽  
Cheryl A. Sadowski
Keyword(s):  
Treatment Options ◽  
Biological Clock ◽  
Bright Light ◽  
Light Therapy ◽  
Supportive Evidence ◽  
Bright Light Therapy ◽  
First Line ◽  
Pharmacologic Management ◽  
Pharmacologic Agents

Objective. To review the evidence for the pharmacologic and non-pharmacologic management of sundowning in patients with dementia. Methods. Databases were searched using the terms sundown, circadian, chronobiological, biological clock, elderly, aged, geriatric, and senior. Studies selected for inclusion assessed potential interventions for the treatment of sundowning or nocturnal agitation. Results. A total of thirteen individual studies and two systematic reviews were evaluated. Study design and outcomes varied, but many measured sleep and nocturnal agitation. Non-pharmacologic interventions that may be of benefit include bright light therapy, music therapy, and aromatherapy. Pharmacologic therapies generally provided minimal benefit and were associated with safety concerns. Supportive evidence was found for the use of melatonin and antipsychotics. Evidence for antidepressants, donepezil, and dronabinol was weaker. Supportive evidence for the use of benzodiazepines was not found and thus cannot be recommended in elderly patients as they are more susceptible to their adverse effects. Conclusion. The number of studies on the management of sundowning is limited and the quality of evidence supporting its treatment is weak. Non-pharmacologic interventions are first line due to safety. Pharmacologic agents are recommended as second line treatment options, in particular antipsychotics and melatonin.

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