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Flashcards in C. Diff Tx Deck (18):
1

Describe the toxins of C. diff

-toxins A and B (which are particularly overexpressed in the NAP-1/027 strain that lacks a protein known as tcdC whose expression normally downregulates transcription of these toxins)

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3

What are the risk factors for C. diff infection?

-ABX use, especially concurrently

-hospitalization, health-care facilities

-age (most common 65-84 yo)

IBD-increased with CD?

Gastric acid suppression (?)

4

What ABX use is especially linked to C. diff?

Clindamycin

Penicillins

Cephalosporins

Fluoroquinolones

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How is C. diff diagnosed?

-clinical suspicion (diarrhea after ABX use) supported by C. diff and/por toxins in stool

-ELISA for toxins A and B (limited sensitivity with frequent false negatives)

7

What are the main tx options for initial C. diff diarrhea?

-Oral metronidazole 500 mg q8h x 10 d for mild-moderate

-oral Vanco (125 mg q6h x 10d) for severe and pregnant/lactating women

-High dose oral Vanco and IV metronidazole for complicated disease

8

T or F. Rectal vanco enemas can be given in pts. with ileus, abdominal distention, and anatomic/surgical abnormalities that prevent oral ABX from reaching the colon

T.

9

How should the 1st recurrence of C diff be tx? 2nd?

1st: same protocol

2nd: oral Vanco

10

T or F. Metronidazole crosses the placenta and is expressed in breast milk

T. Dont give to either

11

What are the AEs of Metronidazole?

-Nausea and metallic taste

-facial anomalies in infants if taken during pregnancy

-increased oral and rectal candida colonization in children if passed through breast milk

-peripheral neuropathy of extremities

 

12

How does Fidaxomicin work?

It is a macrolide that is bactericidal against C. diff via inhbiitng bacterial RNA polymerases (note that there is no cross-resistance with other antimicrobials, including rifamycin due to different site of action)

Minimal/no activit against gram neg anaerobes, facultative anaerobes, and enterobacterioceae

13

How well is fidaxomicin absorbed?

poorly; remains in the GI and eliminated in stool

14

What are the AEs of fidaxomicin?

N/V

abdominal pain

GI bleeding 

15

T or F. In head to head comparison with vanco in groups at high risk for CDI recurrence, fidaxomicin provides a superior clinical response and lower incidence of recurrence

T.

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