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Clostridium difficile – antibiotic therapy

First line
mild , moderate or severe cases Vancomycin 125 mg oral QDS x 10 days VCM -used for Gr + ve bacterial infections cell wall biosynthesis inhibitor branched tricyclic glycosylated peptide with bactericidal activity against most organisms with bacteriostatic effect on enterococci active against most strains of Listeria monocytogenes , Streptococcus pyogen, Streptococcus pneumoniae 
( including MRSA ) , Streptococcus agalactiae , Actinomyces species and Lactobacillus species works by inhibiting the polymerization of peptidoglycan in the bacterial cell wall.

 

GI side effects as abdominal pain , nausea Red-neck syndrome , when used IV ( flushing , pruritus and an erythematous rash on the face , neck and upper torso ) pseudo-allergic Concentration independent antibiotic

 

Second line for a 1st episode of mild moderate or severe C Diff if vancomycin if ineffective. Fidaxomicin 200 mg oral BD x 10 days macrolytic lactone antibiotic inhibits RNA polymerase hence prevents transcription narrow spectrum antibiotic profile bactericidal activity against C Difficile and has a prolonged antibiotic effect has been shown to be as safe as vancomycin but superior to vancomycin in achieving a sustained clinical response for CDI patients with non-BI / NAPI /027 strains.

most common adverse reactions
 are vomiting , nausea and constipation

 

When 1st &2nd line are ineffective Seek specialist advice , they may suggest vancomycin up to 500 mg orally QDS x 10 days WITH or WITHOUT metronidazole 500 mg IV tds x 10 days

 

For a further episode of C Difficile infection within 12 weeks of the symptoms resolution ie relapse vancomycin 125 mg oral QDS x 10 days OR fidaxomicin 200 mg orally BD x 10 days

 

Life threatening refer / seek specialist advice , antibiotics that specialist may initially offer include
 vancomycin 500 mg orally BD x 10 days WITH metronidazole 500 mg IV TDS x 10 days

REFERENCES

  1. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Fidaxomicin. [Updated 2017 Aug 8]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548928/
  2. Medicine compendium via https://www.medicines.org.uk/emc/product/12142/smpc#UNDESIRABLE_EFFECTS
  3. Zhanel, George G et al. “Fidaxomicin: A novel agent for the treatment of Clostridium difficile infection.” The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale vol. 26,6 (2015): 305-12. doi:10.1155/2015/934594
  4. Clostridiodes difficile infection : antimicrobial prescribing NICE guideline 199 https://www.nice.org.uk/guidance/ng199/resources/visual-summary-pdf-9194639149
  5. Pubchem Vancomycin https://pubchem.ncbi.nlm.nih.gov/compound/Vancomycin#section=Computed-Properties

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