8/9/2019 CDC_Clostridium Difficile Infection

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Yasmin El-Sobky, BCPS

Clostridium dif fi cile Infection

Introduction Therapy Clostridium difficileis a gram +ve

anaerobe, spore forming

microorganism. Clostridium difficileis transmitted

by the fecal-oral route.

Overgrowth in the GI tract occurs

after antibiotic therapy.

Production of endotoxins A and B

causes pathogenesis.

Risk factors:

Hospital stays

Use of broad-spectrum antibiotics for

extended periods

Medical comorbidities,

Immunodeficiency states,

advancing age, Extremes of age

Symptoms:

Watery diarrhea,

Abdominal pain,

Leukocytosis,

GIT complications

1. Initial episode and first recurrencea.Metronidazole500 mg orally or IV 3 times/day for 1014 daysMild/Moderate cases

b. Vancomycin125 mg orally 4 times/day for 10

14 daysSevere casesc.Fidaxomicin200 mg orally twice daily for 10 days lower incidence of

recurrence

2. Second and third recurrencesa. Considerfidaxomicinif not already given

Can consider higher dosesof vancomycin(500 mg orally 4 times/day)

b. Taper therapy:vancomycin125 mg orally

4 times/day

for 14 days

2 times/day

for 7 days

and daily

for 7 days

c. Pulse therapy:

Vancomycin course

initial episodefor 1014 days every other dayfor 8 days every 3 daysfor 15 days

d. Considerrifaximin400 mg 2 times/day for 14 days or

nitazoxanide500 mg 2 times/day for 10 days.

Reference: ACCP book, Pharmacotherapy principles and practice, 3rdedition