Clostridium difficile infections antibiotics

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... 

Aronsson B, Mollby R, Nord CE. Clostridium difficile and antibiotic associated diarrhoea in Sweden. Scand J Infect Dis Suppl 1982 35 53-8. 

Libby JM, Jortner BS, Wilkins TD (1982) Effects of the two toxins of Clostridium difficile in antibiotic-associated cecitis in hamsters. In Infect. Immun. 36 822-829. 

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. 

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 is not absorbed after oral administration and must be given intravenously. Oral administrations are used for intraluminal gastrointestinal infections such as antibiotic-associated pseudomembranous colitis produced by Clostridium difficile. Vancomycin is widely distributed in the body but does not cross the blood brain barrier and does not penetrate into bone. It is excreted mainly via the urine, resulting in accumulation in patients with renal insufficiency. Its elimination half-life is 4-11 hours but can increase to 6-10 days in renal failure. 

The spectrum of gastrointestinal tract infections (GTI) cover a wide spectrum from asymptomatic Helicobacter pylori gastritis to self-limiting viral gastroenteritis to food poisoning to bacterial enterocolitis to antibiotic-associated Clostridium difficile colitis to typhoid fever with sepsis and multi-organ failure. 

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. 

The most serious adverse effect is antibiotic-associated (pseudomembranous) colitis (see p. 210) usually due to opportunistic infection of the bowel with Clostridium difficile which produces an entero-toxin clindamycin should be stopped if any diarrhoea occurs. 

Vancomycin is an antibiotic used to treat Staphylococcus and Clostridium difficile.These bacteria infect bones and joints and cause endocarditis and enterocolitis. Vancomycin is commonly prescribed to patients who are susceptible to endocarditis to prevent this infection from occurring. Vancomycin is particularly successful in treating methicillin-resistant strains of bacteria. However, parenteral vancomycin is not used to treat antibiotic-associated pseudomembranous colitis. 

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. 

Invisible killers such as Methicillin Resistant Staphylococcus aureus (MRSA) and other antibiotic resistant pathogens such as Clostridium difficile are a major cause of morbidity and mortality within hospitals worldwide. Current statistics put Ae instances of Hospital Acquired Infection at 300,000 per year incurring an added cost to the health service due to H.A.I. s. In 2000 the estimated cost to the NHS was as much as 1 billion. With instances of HAI s increasing (cases of C-DifBcile rose by 17% in 2005) the need to prevent cross-infection and reduce environmental contamination in hospitals has never been greater. 

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. 

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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