Clostridium difficile infection treatment

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

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. 

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%... 

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 ]. 

Vancomycin (Vancocin) acts against susceptible gram-positive bacteria by inhibiting bacterial cell wall synthesis and increasing cell wall permeability. This drug is used in the treatment of serious gram-positive infections that do not respond to treatment with other anti-infectives. It also may be used in treating anti-infective-associated pseudomembranous colitis caused by Clostridium difficile. 

Wenisch C, Parschalk B, Hasenhundl M, Hirschl AM, Graninger W Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea. Clin Infect Dis 1996 22 813-818. 

Fidaxomicin (tiacumicin B, difimicin, OPT-80, PAR-101) 51 (Optimer Pharmaceuticals) is being evaluated in several Phase III trials for the treatment of patients infected with Clostridium difficile. C. difficile produce toxins that cause inflammation of the colon and severe diarrhoea, which can lead to death in serious infections.84 88 People who contract C. t////7C7/e-associated disease... 

Clostridium difficile is a commensal Gram-positive anaerobic bacterium of the human intestine, found in about 2-5% of the population. C. difficile is the most serious cause of antibiotic-associated diarrhoea and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. Discontinuation of causative antibiotic treatment is often curative. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice. The bacterium produces several known toxins, including enterotoxin (toxin A) and cytotoxin (toxin B), both of which are responsible for the diarrhoea and inflammation seen in infected patients another toxin, binary toxin, has also been described. 

Answer E. Vancomycin is usually considered to be a backup drug to metronidazole in colitis due to Clostridium difficile on the grounds that it is no more effective, is more costly, and should be reserved for treatment of resistant gram-positive coccal infections. None of the other drugs has activity in pseudomembranous colitis—indeed, they may cause it ... 

Antibiotics can be used as either (1) adjunctive treatment along with other medications for active IBD (2) treatment for a specific complication of Crohn s disease or (3) prophylaxis for recurrence in postoperative Crohn s disease. Metronidazole, ciprofloxacin, and clarithromycin are the antibiotics used most frequently. They are more beneficial in Crohn s disease involving the colon than in disease restricted to the Ueum. Specific Crohn s disease-related complications that may benefit from antibiotic therapy include intra-abdominal abscess and inflammatory masses, perianal disease (including fistulas and perirectal abscesses), small bowel bacterial overgrowth secondary to partial small bowel obstruction, secondary infections with organisms such as Clostridium difficile, and postoperative complications. Metronidazole may be particularly effective for the treatment of perianal disease. Postoperatively, a 3-month course of metronidazole (20 mg/kg/day) can prolong the time to both endoscopic and clinical recurrence. 

Metronidazole was initially introduced for the treatment of vaginal infections caused by Trichomonas vaginalis but has since been shown to be effective for treatment of amebiasis, giardiasis, and anaerobic bacterial infections, including Clostridium difficile. 

Gastrointestinal Acute abdominal pain and bloody diarrhea in an adolescent after treatment with co-amoxiclav for an acute urinary infection were due to Klebsiella oxytoca [45 ]. Antibiotic-associated hemorrhagic colitis due to Klebsiella oxytoca differs from antibiotic-associated diarrhea due to Clostridium difficile in being usually segmental and located predominantly in the right colon. 

The safety of continuous intravenous infusion of clindamycin has been evaluated retrospectively in 70 patients with bone and joint infections who were treated with a median daily dose of 2400 mg for a median of 40 days [67 ]. Three developed moderate adverse events an allergic rash, diarrhea not related to Clostridium difficile, and a cytolytic hepatitis, all of which resolved on drag withdrawal. Continuous intravenous infusion of clindamycin may be suitable for parenteral treatment in out-patients. 

Teicoplanin is an antibiotic agent used in the prevention and the treatment of serious infections caused by gram-positive bacteria. It is a semis5mthetic glycopeptide antibiotic with a spectrum of activities similar to vancomycin. Teicoplanin is marketed by Sanofi Aventis Corp. as Targocid . The oral adnunistration of teicoplanin is effective in the treatment of Pseudomembranous colitis and Clostridium difficile-associated diarrhoea, with a comparable efficacy to vancomycin. The effectiveness of teicoplanin and its structure effect on treatment has been reviewed (50). The effect of teicoplanin is directly related to the length of its carbon chain. 

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