H&P performed.
Risk Factors:
Typical Presentation:
Classifying C. diff Severity and Treatment.
DDx reviewed.
Diagnostic Tests:
Treatment
-Contact precautions: Put the patient in contact isolation with enteric precautions. Healthcare team to wash hands before and after patient contact. Hand hygiene with soap and water likely more effective than alcohol-based hand sanitizers in removing C. difficile spores since C. difficile spores are resistant to killing by alcohol.
-D/c inciting antibiotic.
-Avoid antimotility agents e.g. loperamide.
–Severity:
-Prevent excoriation: FlexiSeal Fecal Management System (a rectal tube) to be placed by a nurse when there is excessive diarrhea in patients with severe C. diff.
-Probiotics – Saccharomyces boulardii.
-Low-residue diet.
-Metronidazole and Vancomycin.
–END–
Important Notes
- You don’t treat asymptomatic patients even if they test positive for C. diff. And you shouldn’t test for C.diff. unless a pt has diarrhea.
- Recurrent Clostridium Difficile (Fecal Transplant).
- Classifying and Treating an initial Clostridium difficile Infection.
- Antibiotic-associated diarrhea (AAD).
- Probiotics.
Sample Question
You are treating a pt with severe C. diff with Vancomycin orally. She has a poor clinical response and you decide to alter the antibiotic regimen to include intravenous coverage. What antibiotic can you use IV for C. diff? Metronizadole.
Metronizadole is usually used PO to treat C. diff. Vancomycin is used PO to treat severe C. diff. But metronidazole can also be used IV as an adjunct to PO medication to help treat severe C. diff. IV Vancomycin doesn’t treat C. diff.
Metronidazole, Vancomycin, and fidaxomicin are the three medications recommended for the treatment of Clostridium difficile colitis infections. Only metronidazole is effective intravenously because its biliary excretion and possibly exudation through the colonic mucosa allows it to reach the colon via the bloodstream. Treatment for this condition with vancomycin and fidaxomicin is oral. Imipenem/cilastatin, ciprofloxacin, and meropenem have not been shown to be effective for C. difficile infection.
“Sigmoidoscopy or colonoscopy may be helpful when another cause such as inflammatory bowel disease is suspected. However, they are not recommended for diagnosis because perforation may occur, and pseudomembranes may occur in only half of infected patients.”
References
Gastroenterology. 2009 May;136(6):1899-912
– http://www.gastrojournal.org/article/S0016-5085(09)00292-3/fulltext
– https://www.ncbi.nlm.nih.gov/pubmed/19457418