The Role of Vancomycin and Metronidazole for the Treatment of Clostridium difficile–Associated Diarrhea

2013 ◽  
Vol 26 (5) ◽  
pp. 488-490 ◽  
Author(s):  
Serina B. Tart
Keyword(s):  
Health Care ◽  
Clostridium Difficile ◽  
Expert Panel ◽  
Low Cost ◽  
Pharmacokinetic Profile ◽  
Clinical Severity ◽  
Oral Vancomycin ◽  
Clostridium Difficile Associated Diarrhea ◽  
Health Care Epidemiology

For the treatment of Clostridium difficile–associated diarrhea (CDAD), metronidazole and vancomycin remain the most commonly used agents. The major advantage of metronidazole is its low cost, while the advantage of oral vancomycin is a more favorable pharmacokinetic profile. The epidemiology and clinical severity of CDAD have changed due to the emergence of a hypervirulent strain (BI/NAP1/027). In 2010, the Infectious Diseases Society of America/Society for Health Care Epidemiology of America expert panel defined severe CDAD and recommended oral vancomycin to treat these patients. Metronidazole remains the preferred agent for treatment of mild to moderate CDAD.

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.

Epidemic Clostridium difficile-Associated Diarrhea: Role of Second- and Third-Generation Cephalosporins

1994 ◽  
Vol 15 (2) ◽  
pp. 88-94 ◽  
Author(s):  
David E. Nelson ◽  
Steven B. Auerbach ◽  
Aldona L. Baltch ◽  
Ethel Desjardin ◽  
Consuelo Beck-Sague ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Third Generation ◽  
Clostridium Difficile Associated Diarrhea ◽  
Third Generation Cephalosporins

Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter species

2010 ◽  
Vol 38 (5) ◽  
pp. S25-S33 ◽  
Author(s):  
David J. Weber ◽  
William A. Rutala ◽  
Melissa B. Miller ◽  
Kirk Huslage ◽  
Emily Sickbert-Bennett
Keyword(s):  
Health Care ◽  
Clostridium Difficile ◽  
Acinetobacter Species

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 The correct setting to improve the quality of health care process: a retrospective study in Internal Medicine Department

2018 ◽  
Vol 12 (4) ◽  
pp. 285-295
Author(s):  
Filomena Pietrantonio ◽  
Paola Aperti ◽  
Luca Tonoli ◽  
Elaine Tyndall ◽  
Orietta Meneghetti
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Retrospective Study ◽  
Hospital Stay ◽  
Medical Records ◽  
Clinical Severity ◽  
Early Warning Score ◽  
Care Process ◽  
Technical Equipment

The definition of the role of hospitals and communities in terms of the response to patients’ health care needs is essential in the Lombardy region health-care reform development (LR. 23/2015). The stratification of patients according to clinical severity and care complexity for adequate clinical health care, is achieved by delineating care settings, staff standards, required technical equipment and crucial aspects of clinical pathways. An observational and retrospective study at Manerbio Hospital Internal Medicine Unit (IMU) was carried out to define: i) characteristics of IMU patients; ii) role of IMU physician in management of poly-pathological patients; iii) alternative organizational models. After a Literature review, clinical severity was defined by modifying early warning score, complexity and co-morbidities by cumulative illness rating scale (CIRS) and by intensity of care through care intensity index (IIA). All medical records of patients admitted in the first quarter of 2016 were analyzed. A total of 393 medical records were examined: 199 M/194 F, median age 81 years. Critical patients (requiring continuous monitoring using advanced equipment): 27% of the sample (10% with intensive care transfer criteria). Co-morbidity: between 5 and 6 active diseases for most of the sample; 53% with CIRS between 7 and 12. Elevated care intensity (IIA) was found in 46% of the sample, remaining constant throughout hospital stay. Medium stay: 9.35 days. 27% of IMU patients needs subintensive care. About a quarter of patients has unresolved social problems contributing to acute presentations in the emergency room. Agreement on appropriate links between hospital and community care structures is advisable to reduce hospital stay, adequately responding to patients’ needs.

An Outbreak of Clostridium difficile Necrotizing Enterocolitis: A Case for Oral Vancomycin Therapy?

PEDIATRICS ◽  
1983 ◽  
Vol 71 (6) ◽  
pp. 935-941
Author(s):  
V. K.M. Han ◽  
H. Sayed ◽  
G. W. Chance ◽  
D. G. Brabyn ◽  
W. A. Shaheed
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Neonatal Intensive Care Unit ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Oral Vancomycin ◽  
Vancomycin Therapy ◽  
Etiologic Role

During a 2-month period, 13 infants in this neonatal intensive care unit developed necrotizing enterocolitis, increasing the prevalence in inborns from 5.2 to 20.5/1,000 live births. Fifty-seven perinatal and neonatal factors, many of which have previously been associated with necrotizing enterocolitis, were compared between the infants with necrotizing enterocolitis and 17 unaffected inborn control infants admitted concurrently. Clostridium difficile cytotoxin was detected in the stools of 12 affected infants (92.3%) in comparison with two control infants (11.8%) (P < .001), and the organism was isolated in eight affected neonates (61.5%) compared to none of the control infants (P < .001). The outbreak was terminated upon institution of oral vancomycin therapy in cases and infant contacts, and strict antiinfective measures in the neonatal intensive care unit. This indicates an etiologic role of C difficile in the outbreak. Oral vancomycin in the management of necrotizing enterocolitis was assessed by therapeutic response, drug levels, and occurrence of side effects. Oral vancomycin therapy is indicated in necrotizing enterocolitis outbreaks in units where C difficile is endemic.

Role of the environment in the transmission of Clostridium difficile in health care facilities

2013 ◽  
Vol 41 (5) ◽  
pp. S105-S110 ◽  
Author(s):  
David J. Weber ◽  
Deverick J. Anderson ◽  
Daniel J. Sexton ◽  
William A. Rutala
Keyword(s):  
Health Care ◽  
Clostridium Difficile ◽  
Health Care Facilities ◽  
Care Facilities

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.

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