Comparison of Vancomycin, Teicoplanin, Metronidazole, and Fusidic Acid for the Treatment of Clostridium difficile--Associated Diarrhea

Wenisch, C.; Parschalk, Bernhard; Hasenhündl, M; Hirschl, Alexander M.; Graninger, Wolfgang

doi:10.1093/clinids/22.5.813

Cited by 454 publications

(265 citation statements)

References 23 publications

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“…Excretion of toxin approximates 13% to 24% at 2 weeks and 6% at 4 weeks after therapy. 26,27 Given that NAAT testing is more sensitive than toxin assays, an interval greater than 4 weeks since last testing should be used for testing with a recurrence.…”

Section: Diagnostic Testingmentioning

confidence: 99%

Clostridium difficile Infection in Infants and Children

Schutze¹,

Willoughby²

2013

Pediatrics

226

100

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Infections caused by Clostridium difficile in hospitalized children are increasing. The recent publication of clinical practice guidelines for C difficile infection in adults did not address issues that are specific to children. The purpose of this policy statement is to provide the pediatrician with updated information and recommendations about C difficile infections affecting pediatric patients. Pediatrics

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Section: Diagnostic Testingmentioning

confidence: 99%

Clostridium difficile Infection in Infants and Children

Schutze¹,

Willoughby²

2013

Pediatrics

226

100

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“…Patients may still shed C. difficile in their stool after diarrhea resolves. [46][47][48] B. Approaches to minimize CDI transmission from the environment 1.…”

Section: Place Patients With Diarrhea Under Contact Precautions Whilementioning

confidence: 99%

“…Area of controversy: Previous research has demonstrated that asymptomatically colonized patients can be a source of transmission of C. difficile and that patients can remain colonized after symptoms cease. 38,39,[47][48][49] However, asymptomatically colonized patients are less likely than symptomatic patients to contaminate their surrounding environment or serve as a source of transmission. In some settings, the duration of contact precautions can be extended if there is concern that asymptomatically colonized patients represent a significant source of potential C. difficile exposure.…”

Section: Place Patients With Diarrhea Under Contact Precautions Whilementioning

confidence: 99%

Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals

Dubberke

Gerding

Classen

et al. 2008

Infect. Control Hosp. Epidemiol.

189

194

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Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Increasing rates of CDIC. difficile now rivals methicillin-resistant Staphylococcus aureus (MRSA) as the most common organism to cause healthcare-associated infections in the United States.a. In the United States, the proportion of hospital discharges in which the patient received the International Classification of Diseases, Ninth Revision discharge diagnosis code for CDI more than doubled between 2000 and 2003, and CDI rates continued to increase in 2004 and 2005 (L. C. McDonald, MD, personal communication, July 2007). These increases have been seen in pediatric and adult populations, but elderly individuals have been disproportionately affected. CDI incidence has also increased in Canada and Europe.b. There have been numerous reports of an increase in CDI severity.c. Most reports of increases in the incidence and severity of CDI have been associated with the BI/NAP1/027 strain of C. difficile. This strain produces more toxins A and B in vitro than do many other strains of C. difficile, produces a third toxin (binary toxin), and is highly resistant to fluoroquinolones.

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“…Antibiotic stewardship is recommended to reduce the risk of CDI. (Strong recommendation, high-quality evidence) 33. Contact precautions for a patient with CDI should be maintained at a minimum until the resolution of diarrhea.…”

mentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,478

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Comparison of Vancomycin, Teicoplanin, Metronidazole, and Fusidic Acid for the Treatment of Clostridium difficile--Associated Diarrhea

Cited by 454 publications

References 23 publications

Clostridium difficile Infection in Infants and Children

Clostridium difficile Infection in Infants and Children

Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

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