Tx for C. diff: Sweatman

Question 1

Describe the risk factors for C. diff infection and explain the current recommendations regarding drug therapy.

Answer 1

RFs: Old, hospitalized, on Abx (clinda, pen, cephalosporins, fluoroquinolones), IBD

Current recommendations:
Oral metronidazole for mild/moderate cases
Do NOT use in preg/lact women!

Oral vanc for severe cases and preg./lactating women
Also, treat 2nd recurrurrence (3rd case) with oral vanc

Complicated dz: high dose PO vanc and IV metronidazole

Question 2

Compare the effectiveness of fidaxomicin and vancomycin in treating pts at high risk for CDI recurrence.

Answer 2

Overall, fidaxomicin provides superior clinical response and lower incidence of recurrence.
It is more expensive, but can be justified bc the cost of treating recurrences would be more than treating once with Fidaxomicin.

Question 3

Discuss the role and effectiveness of fecal microbiota transplantation in tx of CDI, including preparation of donor and recipient.

Answer 3

Prep of donor:
No recent abx, screened for fecal pathogens, screened for STIs, soften stool.

Prep of recipient:
Colonoscopy prep to clean colon, stop abx 2-3 days prior to use, antidiarrheal Loperamide after tx.

90% of patients experienced clinical resolution following fecal transplant in one study. More studies needed.