scholarly journals Efektivitas Pemberian Vankomisin Oral Terhadap Kolitis Infektif pada Anak

Sari Pediatri ◽  
2021 ◽  
Vol 23 (1) ◽  
pp. 57
Author(s):  
Jeshika Febi Kusumawati ◽  
Muzal Kadim
Keyword(s):  
Clostridium Difficile ◽  
Oral Vancomycin ◽  
Oral Metronidazole

Latar belakang. Kolitis bermanifestasi sebagai diare kronik dan pada anak perlu diwaspadai karena memiliki komplikasi gangguan tumbuh kembang dan kematian. Sepuluh hingga dua puluh persen kasus diare infeksi akibat perawatan di rumah sakit disebabkan oleh Clostridium difficile. Metronidazol dan vankomisin oral masih menjadi terapi obat lini pertama untuk infeksi Clostridium difficile. Pada pasien diare berat, studi menunjukkan vankomisin oral menjadi pilihan utama dibandingkan metronidazole.Tujuan. Mengetahui efektifitas pemberian vankomisin oral terhadap metronidazol oral dalam menyembuhkan kolitis infektif kronik pada anak.Metode. Pencarian literatur melalui Pubmed dan Cochrane pada bulan Juli 2019 dengan kata kunci “children OR pediatric” AND “infective colitis OR Clostridium difficile” AND “oral vancomycin” AND “ oral metronidazole”.Hasil. Penelusuran artikel pada makalah ini menemukan dua artikel yang relevan terhadap pertanyaan klinis. Igarashi dkk. merupakan meta analisis terhadap lima uji klinis acak dengan total 1101 pasien dan dipublikasikan pada tahun 2018. Artikel yang kedua adalah studi pilot prospektif observatif dari Antoon dkk pada 8 subyek anak berusia 8-17 tahun pada tahun 2016.Kesimpulan. Vankomisin oral disarankan untuk digunakan dalam kolitis infektif berat. Untuk kasus kolitis infektif yang ringan atau sedang, data menunjukkan hasil yang seimbang untuk vankomisin dan metronidazol. Berdasarkan uji observasional, vankomisin oral tidak diabsorbsi dalam darah pada anak.

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.

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.

Lack of Increased Colonization with Vancomycin-Resistant Enterococci during Preferential Use of Vancomycin for Treatment during an Outbreak of Healthcare-Associated Clostridium difficile Infection

2010 ◽  
Vol 31 (7) ◽  
pp. 710-715 ◽  
Author(s):  
Mark Miller ◽  
Lisa Bernard ◽  
Melissa Thompson ◽  
Daniel Grima ◽  
Jocelyne Pepin
Keyword(s):  
Clostridium Difficile ◽  
Oral Vancomycin ◽  
Outbreak Period ◽  
Vancomycin Resistant Enterococci ◽  
Period 2 ◽  
Jewish General Hospital ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

Objective.To assess whether use of oral vancomycin for treatment during an outbreak of Clostridium difficile infection (CDI) was associated with increased rates of colonization with vancomycin-resistant enterococci (VRE)..Design.A retrospective analysis of hospital databases.Setting.The Jewish General Hospital in Montreal, Quebec, Canada.Methods.We collected data regarding VRE colonization and CDI from November 1, 2000, through September 30, 2007, during which policies of preferential oral metronidazole or vancomycin treatment were implemented to control an outbreak of CDI. Four periods were considered: period 1, the preoutbreak period when metronidazole was used; period 2, the CDI outbreak period when metronidazole was used; period 3, the postoutbreak period when vancomycin was used; and period 4, the postoutbreak period when metronidazole was used.Results.A total of 2,412 cases of CDI and 425 cases of VRE colonization were identified. The rate of CDI increased significantly during period 2 and decreased to preoutbreak levels during period 3. The rate of VRE also increased during period 2 and decreased during the first 18 months of period 3. A clonal outbreak of cases of VRE (VanA) colonization was observed toward the end of period 3 and into period 4. Excluding the period of the clonal outbreak, there was a strong correlation between the number of cases of CDI and VRE colonization (r = 0.736; P = .001) and a negative association between VRE colonization and vancomycin use (r = —0.765; P = .04).Conclusions.Increased vancomycin use was not associated with an increase in VRE colonization over a 2-year period. Restriction of vancomycin use during CDI outbreaks because of the fear of increasing VRE colonization may not be warranted.

scholarly journals Both Oral Metronidazole and Oral Vancomycin Promote Persistent Overgrowth of Vancomycin-Resistant Enterococci during Treatment of Clostridium difficile-Associated Disease

2008 ◽  
Vol 52 (7) ◽  
pp. 2403-2406 ◽  
Author(s):  
Wafa N. Al-Nassir ◽  
Ajay K. Sethi ◽  
Yuejin Li ◽  
Michael J. Pultz ◽  
Michelle M. Riggs ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Prospective Observational Study ◽  
Oral Vancomycin ◽  
The Past ◽  
Vancomycin Resistant Enterococci ◽  
Stool Samples ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

ABSTRACT For treatment of mild to moderate Clostridium difficile-associated disease (CDAD), oral metronidazole has been recommended as the preferred agent, in part due to concern that vancomycin may be more likely to promote colonization by vancomycin-resistant enterococci (VRE). We performed a prospective observational study to examine the effects of oral metronidazole or vancomycin treatment of CDAD on acquisition and concentration of VRE stool colonization. Before, during, and after 90 courses of CDAD therapy, stool samples were cultured for VRE, and the concentrations were quantified. Eighty-seven subjects (97%) had received antibiotics within the past month. For 56 treatment courses in which preexisting VRE colonization was present, metronidazole (n = 37 courses) and vancomycin (n = 19 courses), each promoted persistent VRE overgrowth during therapy, and the concentration decreased significantly in both groups by ∼2 weeks after completion of treatment (P <0.049). For 34 treatment courses in which baseline cultures were negative for VRE, new detection of VRE stool colonization occurred during 3 (14%) of the 22 courses of metronidazole and 1 (8%) of the 12 courses of vancomycin (P = 1.0). These results demonstrate that both oral metronidazole and oral vancomycin promote the overgrowth of VRE during treatment of CDAD. New CDAD treatments are needed that are less likely to disrupt the intestinal microflora and promote overgrowth of healthcare-associated pathogens.

scholarly journals Impact of an Automatic Hospital Probiotic Protocol on Clostridium difficile Infection Rates and Antibiotic Usage Patterns

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S2-S2
Author(s):  
Douglas Slain ◽  
Amy Georgulis ◽  
Ronald Dermitt ◽  
Laura Morris ◽  
Stephen Colodny
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Community Hospital ◽  
Pcr Analysis ◽  
Infection Rates ◽  
Oral Vancomycin ◽  
Protocol Implementation ◽  
Increased Risk ◽  
Before And After ◽  
Oral Metronidazole

Abstract Background The use of probiotics in hospitalized patients ordered antibiotics has been associated with a preventative effect against Clostridium difficile infection (CDI) in a few small studies and meta-analyses. Starting in 2014, all adult patients admitted to our 330-bed community hospital who were started on an antibiotic automatically received a course of the probiotic Saccharomyces boulardii (SB). Our study provides a much larger experience with which to assess the preventative use of SB in patients receiving concomitant antibiotics. Methods Rates of CDI were compared during the 3-year periods before and after the automatic SB protocol implementation. CDI infection rates using ICD-9 code and CDC hospital-associated infection (HAI) definitions were compared. The use of CDI treatment agents (oral vancomycin and oral metronidazole) expressed in DDD/1,000 patient-days, and rates of SB infections/cultures were also assessed. All rates were standardized per hospital census. Clostridium difficile laboratory detection was performed by PCR analysis throughout the study period. Results Case rates of CDI using ICD-9 or CDC HAI definitions did not differ before and after protocol implementation (P = 0.165 and P = 0.521, respectively). The use of CDI treatment antibiotics were also similar; oral metronidazole (P = 0.269), oral vancomycin (P = 0.938), total CDI agents (P = 0.633). Positive specimen cultures for SB where identified in two patients prior to protocol and in 27 patients during the protocol years. Actual SB infections from sterile body sites were identified in five patients during the protocol vs. only one case in the pre-protocol years (P = 0.035). The average yearly cost of SB prophylaxis was $63,000. Conclusion In our global assessment of this data, the use of an automatic SB protocol at our community hospital was not associated with a protective effect against CDI. The use of SB was associated with an increased risk of SB infections. Further study of SB and other probiotic formulations for CDI prevention are warranted. Disclosures All authors: No reported disclosures.

scholarly journals 1593. Recurrence of Clostridium difficile Infection in Multiple Myeloma Patients Receiving Prophylactic Oral Vancomycin or Oral Metronidazole vs. No Prophylaxis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S498-S499
Author(s):  
Gisele Moran ◽  
Naveen Yarlagadda ◽  
Sandra Susanibar ◽  
Atul Kothari ◽  
Juan Carlos Rico ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Oral Vancomycin ◽  
Oral Metronidazole
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