E4 GI (C diff)

Question 1

how is C diff transmitted

Answer 1

person to person via fecal-oral route (ew)

Question 2

2 highlighted C diff risk factors

Answer 2

• PPIs/H2rAs
• chemo

Question 3

2 highest risk antibiotics for C diff (1 class, 1 drug)

Answer 3

• FQs
• clinda

Question 4

two primary sxs of C diff

Answer 4

• profuse, watery or green, foul-smelling diarrhea
• abdominal pain

Question 5

4 additional s/sxs of C diff

Answer 5

• fever
• leukocytosis
• hypoalbuminemia
• AKI

Question 6

CDI or AAD:
evidence of colitis

Answer 6

CDI

Question 7

CDI or AAD:
epidemic or endemic pattern

Answer 7

CDI

Question 8

CDI or AAD:
resolves when antibiotics stopped

Answer 8

AAD

Question 9

when to test for C diff?

Answer 9

3 or more profuse, watery or mucoid green, foul-smelling shits in 24 hours

Question 10

3 testing methods for C Diff. which one does IU health use?

Answer 10

• NAAT alone
• Antigen test (GDH) + Toxin A/B test ***
• NAAT + Toxin A/B test

Question 11

Non-severe C diff:
WBC: ?
SCr: ?

Answer 11

WBC: <15,000/mcL
SCr: <1.5

Question 12

severe C diff:
WBC: ?
SCr: ?

Answer 12

WBC: >15,000
SCr: >1.5

Question 13

fulminant C diff:
(3)

Answer 13

• hypotension or shock
• Ileus
• Toxic megacolon **

Question 14

standard of care C diff tx option

Answer 14

oral vanc

Question 15

T or F:
Fidaxomicin has a broader spectrum compared to vanc

Answer 15

false, narrower

Question 16

Has higher rates of sustained response:
A. Oral vanc
B. Fidaxomicin

Answer 16

B

Question 17

What C diff tx option is no longer recommended first line and is reserved for fulminant cases as an ADDITIONAL agent

Answer 17

metro (iv or po)

Question 18

1 PK/PD consideration for oral vanc

Answer 18

extremely poor oral bioavailability, but this is good bc we want it at the site of infxn

Question 19

difference b/w standard and fulminant oral vanc dosing

Answer 19

fulminant is a lot more, still q6h tho

Question 20

2 PK/PD considerations for fidaxomicin

Answer 20

• protein synthesis inhibitor
• extremely poor oral absorption

Question 21

1 major downside for fidaxomicin even tho its lowkey the DoC

Answer 21

$4,500 a dose damn

Question 22

1 PK/PD consideration for metro

Answer 22

excellent oral absorption

Question 23

metro dosing method for standard vs fulminant

Answer 23

oral for standard
IV for fulminant

Question 24

Tx options for C diff, initial episode, NON-severe:
(“in order of preference”) (3)

Answer 24

• fidax
• oral vanc
• metro (only if other options arent feasible)

Question 25

Tx options for C diff, initial episode, SEVERE: ("in order of preference") (2)

Answer 25

- fida - vanc

Question 26

what random ass drug to avoid with C diff/C diff tx

Answer 26

loperamide

Question 27

general tx approach with recurrent CDI

Answer 27

change something, either drug or dose

Question 28

tx options for first CDI RECURRENCE (in order of preference) (4)

Answer 28

- fida x 10 days (if not used initial) - vanc x 10 days (if not used initial) - fida x 5 days then x 20 days (extended dosing) - vanc tapered and pulsed regimen

Question 29

tx options for second and subsequent CDI RECURRENCE (in order of preference)

Answer 29

same as first but select a different one

Question 30

tx options for fulminant CDI (in order of preference) (2 with one weird consideration)

Answer 30

- vanc + metro - IF ILEUS PRESENT -> add vanc enema

Question 31

Tx duration for fulminant

Answer 31

not well defined (only for fulminant)***

Question 32

3 risk factors for CDI recurrence

Answer 32

- age >65 - severe CDI on presentation - immunocompromised host

Question 33

4 tx options to reduce CDI recurrence

Answer 33

- fecal microbiota transplant - Rebyota (fecal microbiota suspension) - Vowst (bacterial spore suspension) - Bezlotoxumab

Question 34

FMT is utilized as both a ________ option and _______ to reduce recurrence of CDI

Answer 34

treatment, method

Question 35

2 potential indications for FMT

Answer 35

- 3 or more episodes of CDI - poor response to initial therapy for CDI

Question 36

2 pt considerations for FMT

Answer 36

- requires admin via endoscopy, colonoscopy, or enema - not available at all hospitals

Question 37

Rebyota indication (1)

Answer 37

prevention of recurrence of CDI for pts following antibiotic tx for recurrent CDI (2nd line)

Question 38

how and when do you administer Rebyota?

Answer 38

rectal tube, 24-72 hours after tx is completed*

Question 39

2 pt considerations for rebyota

Answer 39

- admin via rectal tube - super expensive

Question 40

2 Vowst basics

Answer 40

- bacterial spore suspension - modulate bile acid conc. and restore fatty acids >> resistance to C diff colonization and restoration of gut microbiome

Question 41

indication of Vowst

Answer 41

prevention of recurrence of CDI for pts following antibiotic tx for recurrent CDI

Question 42

how and when to start Vowst

Answer 42

oral, 2-4 days after tx completion

Question 43

2 pt considerations for Vowst

Answer 43

- oral - super expensive

Question 44

5 AE's for Vowst

Answer 44

- abdominal distension - fatigue - constipation - chills - diarrhea

Question 45

Bezlotoxumab is a mab targeting C diff toxin __ to neutralize its effect

Answer 45

B

Question 46

Bezlotoxumab indication

Answer 46

prevention of recurrence of CDI for pts at high risk for CDI recurrence

Question 47

how and when to give bezlotoxumab

Answer 47

IV 1 dose DURING course of CDI tx

Question 48

2 pt considerations for bezlotoxumab

Answer 48

- caution in pts with CHF* - also expensive