Clostridium difficile infections

Rifaximin Rifamycin Antibiotic Gut bacteria Enteric infection Diarrhea, infectious Hepatic encephalopathy Small intestine bacterial overgrowth Inflammatory bowel disease Colonic diverticular disease Irritable bowel syndrome Constipation Clostridium difficile infection Helicobacter pylori infection Colorectal surgery Bowel decontamination, selective Pancreatitis, acute Bacterial peritonitis, spontaneous Nonsteroidal anti-inflammatory drug enteropathy... 

Zimmerman MJ, Bak A, Sutherland LR Review article Treatment of Clostridium difficile infection. Aliment Pharmacol Ther 1997 11 1003-1012. 

Wilcox MH, Spencer RC Clostridium difficile infection Responses, relapses and reinfections. J Hosp Infect 1992 22 85-92. 

McFarland LV, Stamm WE Nosocomial Clostridium difficile infection (letter). N Engl J Med 1989 321 190. 

Karjalainen, T., Waligora-Dupriet, A. J., Cerquetti, M., Spigaglia, P., Maggioni, A., Mauri, P., and Mastrantonio, P. (2001). Molecular and genomic analysis of genes encoding surface-anchored proteins from Clostridium difficile. Infect. Immun. 69,3442-3446. 

Gerding DN, Mnto CA, Owens RC. (2008) Treatment of Clostridium difficile infection. Clin Infect Dis 46 S32-S42. 

Gerber M, Ackermann G (2008). OPT-80, a macrocychc antimicrobial agent for the treatment of Clostridium difficile infections A review. Expert Opin Inv Drugs 17 547-553. 

A small increased risk of enteric infections may exist in patients taking proton pump inhibitors, especially when traveling in underdeveloped countries. Hospitalized patients may have an increased risk for Clostridium difficile infection. 

Rupnik M, Wilcox MH, Gerding DN (2009) Clostridium difficile infection new developments in epidemiology and pathogenesis. Nat Rev Microbiol 7 526... 

Borriello SP. 12th C. L. Oakley lecture. Pathogenesis of Clostridium difficile infection of the gut. J Med Microbiol 1990 33(4) 207-15. 

Anand A, Glatt AE. Clostridium difficile infection associated with antineoplastic chemotherapy a review. Clin Infect Dis 1993 17(1) 109-13. 

Ozawa TT, Valadez T. Clostridium difficile infection associated with levofloxacin treatment. Tenn Med 2002 95(3) 113-15. 

Vancomycin (oral) 125-250 mg q.8hr 0% 100% 100% 100% Oral vancomycin is indicated only for the treatment of Clostridium difficile infections 100% 100% 100%... 

Adverse reactions Overall, the penicillins are well tolerated. The most common adverse effects are due to hypersensitivity reactions. Hypersensitivity reactions can be simply categorized as immediate reactions (type 1) or late reactions. Type 1 reactions are IgE mediated and are often associated with systemic manifestations such as diffuse erythema, pruritus, urticaria, angioedema, and bronchospasm. The most severe yet rare IgE-mediated side effect is anaphylaxis (0.05%). Type 1 reactions usually occur within 72 hr of administration. Late reactions usually occur 72 hr after drug administration. The most common late reactions include skin rashes characterized as maculopapular or morbilliform rashes. Rarely, nafcillin may cause neutropenia. Seizures in high doses, vaginal moniliasis, and Clostridium difficile infection also can occur with all penicillins... 

Greenberg ML, Hendrickson RG, and Muller AA (2003) Occupational exposure to cephalosporins leading to Clostridium difficile infection. Journal of Toxicology. Clinical Toxicology 41 205-206. 

Significant deficiencies in the security and control of samples have been well documented. " " In fact, it has been estimated that just over half of samples actually reach patients. Samples may be used by prescribers and staff, or they may be diverted. Personal use of drug samples by physicians and other healthcare providers raises ethical concerns and is not without risk." Limaye and Paauw described three medical residents who self-prescribed antimicrobials and were subsequently diagnosed with Clostridium difficile infection." Tong and Lien reported self-medication with samples and distribution of samples to nonphysicians by almost 60% of pharmaceutical representatives surveyed at a Canadian family practice office. A contributing factor to some of these issues is that institutional or facility sample policy and procedures are often absent, or compliance is poor. One institution found only 10% compliance when the inventory of samples was compared with the required written documentation. Even after an educational program in which the policy was explained to the house staff, a second audit found only 26% compliance. " Poor compliance with policy and procedure may jeopardize patient safety, as well as put the institution at risk for JCAHO recommendations or Board of Pharmacy penalties. 

McFarland LV, Mulligan ME, Kwok RY, et al. Nosocomial acquisition of Clostridium difficile infection. New Engl J Med 1989 320 204— 210. 

Barbut, F., Mastrantonio, P., Delmee, M., Brazier, J., Kuijper, E., and Poxton, 1. (2007). European study group on Clostridium difficile (ESGCD). Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates. Clin. Microbiol. Infect. 13,1048-1057. 

Gurian, L., Ward, T. T., and Katon, R. M. (1982). Possible foodborne transmission in a case of pseudomembranous colitis due to Clostridium difficile Influence of gastrointestinal secretions on Clostridium difficile infection. Gastroenterology 83, 465 69. 

Jones, R. L., Adney, W. S., Alexander, A. F., Shideler, R. K., and Traub-Dargatz, J. L. (1988b). Hemorrhagic necrotizing enterocolitis associated with Clostridium difficile infection in four foals. J. Am. Vet. Med. Assoc. 193, 76-79. 

Metronidazole is used increasingly as primary therapy for pseudomembranous colitis due to Clostridium difficile infection. At doses of250-500 mg orally three times daily for 7-14 days, metronidazole is effective and less expensive than oral vancomycin. Metronidazole also is used in patients with Crohn s disease who have perianal fistulas or significant colonic disease fsee Chapter 38). 

An elderly woman who had been treated with low-dose methotrexate 5 mg weekly and loxoprofen for one month developed acute pyelonephritis. Intravenous eefotiam was started, and on day 7 she developed severe watery diarrhoea. Analysis showed pancytopenia and Clostridium difficile infection. Methotrexate and cefotiam were stopped, and vancomycin started, and the patient reeovered. It was suggested that the combination of the antineoplastic drug and antibacterial increased the risk of Clostridium difficile diarrhoea. In addition, the NSAID (see Methotrexate + NSAIDs , p.649) and renal impairment from the pyelonephritis could have eontrib-uted to the methotrexate toxicity. This appears to be an isolated ease, and any interaetion with cefotiam is not established. 

Walk, S.T. and Young, V.B. 2008. Emerging insights into antibiotic-associated diarrhea and Clostridium difficile infection through the lens of microbial ecology. Interdiscip Perspect Infect Dis. Article ID 125081. doi 10.1155/2008/125081. 

The Toolkit for Reduction of Clostridium difficile through Antimicrobial Stewardship assists hospital staff and leadership in developing an effective antimicrobial stewardship program (ASP) with the potential to reduce Clostridium difficile infection (C. difficile), a serious public health problan that has recently increased in both incidence and severity. An ASP is a systematic approach to developing coordinated interventions to reduce overuse and inappropriate selection of antibiotics, and to achieve optimal outcomes for patients in cost-efficient ways. ASPs targeted to C. difficile reduction show promise because increased rates of C. difficile are associated with inappropriate antibiotic use. 

Hopkins MJ, Macfarlane GT. Changes in predominant bacterial populations in human feces with age and with Clostridium difficile infection. / Med Microbiol. 2002 51 448—454. 

Barlett, J.G., and Gerding, G.N. 2008. Clinical Recognition and Diagnosis of Clostridium difficile Infection. Clin Infect Dis. 46 (Supplement 1), S12-S18. 

An anaphylactic reaction was reported following 500 mg of oral vancomycin to treat severe Clostridium difficile infection. The patient was a 35-year-old posttransplant cystic fibrosis man who had several documented IgE reactions to antibiotics including cefepime, piperacillin as well as latex [81 ]. Five patients over a period of 4years at the Massachusetts General Hospital were reported to have developed DRESS syndrome in association with vancomycin use. Onset of symptoms varied from 12 days to 4 weeks after starting treatment and should be considered in subjects presenting late with typical findings [82 ]. 

Bosse D, Lemire C, Ruel J, Cantin AM, Menard F, Valiquette L. Severe anaphylaxis caused by orally administered vancomycin to a patient with Clostridium difficile infection. Infection 2013 41(2) 579-82. 

McBride, S.M. and Sonenshein, A.L. (2011). Identification of a genetic locus responsible for antimicrobial peptide resistance in Clostridium difficile. Infect Immun 79,167-176. 

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