Evolving Treatment Strategies for Severe Clostridium difficile Colitis: Defining the Therapeutic Window

Kim, Peter K.; Zhao, Peng; Teperman, Sheldon

doi:10.1007/978-3-319-59704-1_15

Cited by 3 publications

(1 citation statement)

References 69 publications

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“…We do not recommend use of a rectal Malecot instead of a Foley catheter, as this tube does not have a balloon to occlude the rectal lumen, and therefore will not result in a true retention enema. Similarly, vancomycin should not be instilled via the irrigation port of fecal management systems, as this approach fails to deliver the drug to the proximal colon and will not result in a retention enema [21].…”

Section: Discussionmentioning

confidence: 99%

Vancomycin Enema in the Treatment ofClostridium difficileInfection

Fawley

Napolitano

2019

Surgical Infections

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Background: Current guidelines for the treatment of Clostridium difficile infections (CDIs) recommend vancomycin enemas for patients with adynamic ileus. There is significant variability in guideline recommendations for vancomycin dose and enema volume and whether a retention enema should be used. The most recent (2017) guidelines from the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America recommend rectal instillation of 500 mg of vancomycin in 100 mL of physiologic saline every 6 hours as a retention enema. Methods: Published studies regarding vancomycin enema use in CDI (1990-present) were reviewed to compare drug dose, volume, and whether a retention enema was used in order to determine the efficacy and make recommendations for optimal dosing. Results: Case series with higher vancomycin dose, higher enema volume, and use of retention enema demonstrated greater efficacy. Use of smaller volumes and lower doses (100 mL; 125-250 mg q 6 hours) demonstrated no efficacy of intracolonic vancomycin. Conclusion: We recommend revision of the current CDI guideline recommendations for patients with adynamic ileus to the following: Vancomycin per rectum (500 mg in a volume of 500 mL q 6 hours) by retention enema (18F Foley catheter with 30-cc balloon inserted into the rectum, balloon inflated, solution instilled, and catheter clamped for 60 minutes) for optimal efficacy.

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Section: Discussionmentioning

confidence: 99%

Vancomycin Enema in the Treatment ofClostridium difficileInfection

Fawley

Napolitano

2019

Surgical Infections

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Clostridium difficile Infection in Surgical Patients

Woods

Bhatt

Coimbra

2021

Infections in Surgery

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2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

et al. 2019

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In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.

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Evolving Treatment Strategies for Severe Clostridium difficile Colitis: Defining the Therapeutic Window

Cited by 3 publications

References 69 publications

Vancomycin Enema in the Treatment ofClostridium difficileInfection

Vancomycin Enema in the Treatment ofClostridium difficileInfection

Clostridium difficile Infection in Surgical Patients

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

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