Infusion Medications For C Diff Infection
Currently there are a few different infusion medications available to treat C. diff infections:
- Metronidazole is the second most common antibiotic treatment for C. diff and can be given orally for via IV infusion. It is useful as a first-line therapy for mild-to-moderate cases, but not generally prescribed for severe cases.
- Zinplava . Unlike vancomycin and metronidazole, Zinplava is not an antibiotic but rather a monoclonal antibody. While Zinplava does not treat the infection itself, it binds to the C. diff. Toxin B in order to reduce recurrence of the infection. Alongside antibiotic treatment, Zinplava has proven to be an effective treatment option for patients with C. diff.
Is This Information Right For Me
This information is right for you if:
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Your health care professional has said that you or someone you care for has a Clostridium difficile infection . CDI causes watery diarrhea and cramping in your belly. Clostridium difficile is also often called “C. difficile” or “C. diff.”
- You are age 18 or older. This information is from research on adults.
Treatment Of Severe Or Fulminant Cdi
The BI/NAP1 strain has been associated with greater infection severity, as mentioned above . If severe CDI is suspected after obtaining the patient’s history and performing a physical examination, then radiographic imaging studiesusually a CT scan of the abdomen and pelvisare indicated to determine whether ileus, obstruction, perforation, toxic mega-colon, colonic-wall thickening, and ascites are present . When any of these conditions are presentparticularly toxic megacolon, perforation, or colonic-wall thickeningearly surgical consultation is indicated, because colectomy can be a life-saving procedure . Additional criteria for severe CDI may include signs of sepsis, hypotension, a WBC count that is markedly high or low , and increased bandemia , in the absence of other obvious causes.
For patients with severe or fulminant infection whose gastrointestinal tract is functioning, oral vancomycin is the preferred therapy. A recent prospective, double-blind, randomized clinical study indicated that the clinical cure rate for vancomycin in patients with severe CDI was significantly better than that for metronidazole . Monitoring for signs of response to therapy must be done daily because severe CDI is life threatening, and appropriate therapeutic decisions, particularly whether to perform a colectomy, need to be made promptly.
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Preventing C Difficile Infection
1.3.1 For how to prevent C. difficile infection through good antimicrobial stewardship, infection control and environmental hygiene measures, see:
1.3.2 Ensure a diagnosis of C. difficile infection is recorded . This is so that it can be taken into account before any future antibiotics are prescribed.
1.3.3 Do not offer antibiotics to prevent C. difficile infection.
1.3.4 Do not advise people taking antibiotics to take prebiotics or probiotics to prevent C. difficile infection.
For more details, see the summary of the evidence.
Which Antibiotics Cause Clostridium Difficile Colitis
- vancomycin , and
- aminoglycosides .
In fact, metronidazole and vancomycin are two antibiotics that are used for treating C. difficile colitis however, there are rare reports of C. difficile colitis occurring several days after stopping metronidazole.
While most C. difficile colitis in the US is caused by antibiotics, C. difficile colitis also can occur in patients without exposure to antibiotics. For example, patients with ulcerative colitis and Crohn’s disease have been known to develop C. difficile colitis without exposure to antibiotics.
Since many antibiotics can cause C. difficile infection, all antibiotics should be used prudently. Self-administration or using antibiotics without an accurate diagnosis or a proper reason should be discouraged. On the other hand, benefits of properly prescribed antibiotics for the right reasons usually far outweigh the risk of developing C. difficile colitis.
Antibiotics can sometimes cause diarrhea that is not due to C. difficile infection. The reason for the diarrhea is not clear. The practical implication is that not all diarrhea associated with antibiotics should be considered to be due to C. difficile and treated as such.
History
Laboratory tests
Flexible sigmoidoscopy and colonoscopy
X-rays
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What Are The Signs And Symptoms Of Clostridium Difficile Colitis
Patients with severe C. difficile colitis may have:
- a high fever of 102 F to 104 F ,
- severe diarrhea with blood, and
- severe abdominal pain and tenderness.
Severe diarrhea also can lead to dehydration and disturbances in the electrolytes in the body. Rarely, severe colitis can lead to life-threatening complications such as toxic megacolon , peritonitis , and perforation of the colon.
What Puts A Person At Risk Of Getting C Difficile Infection
People in healthcare settings are most at risk of acquiring this type of infection because C. difficile is often a healthcare-associated infection. These types of infections can be transmitted within a hospital when infection prevention and control measures are not followed.
Those at higher risk include the elderly, people with severe underlying illness, and people taking certain antibiotics or cancer chemotherapy. In addition, patients taking stomach ulcer drugs, known as proton pump inhibitors, are at increased risk for contracting C. difficile infection.
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Why Is This Medication Prescribed
Bezlotoxumab injection is used to decrease the risk of Clostridium difficile infection from coming back in people who are at high risk for C. difficile infection and who are already taking an antibiotic drug to treat Clostridium difficile. Bezlotoxumab is in a class of medications called monoclonal antibodies. It works by binding to a C. difficile toxin to stop its effects on the body.
Infusion Therapy Treatment For C Diff Infection
Clostridium difficile, more commonly referred to as C. diff, is a type of bacteria that can cause serious infections and illness in the gastrointestinal system. Most frequently, the development of C. diff occurs after prolonged antibiotic treatment especially among the elderly and those with weakened immune systems. In mild cases of C. diff, patients may only experience diarrhea for a few days and some abdominal cramping. In severe cases, however, these symptoms are more intense and can also include:
- Fever
- Bloody stools
- Kidney failure
C. diff. can be a serious condition to overcome, but treatments like infusion therapy can help.
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Options For Treating C Diff
Two medications are typically used for C. diff: metronidazole, which is used ”off-label” as it is not approved by the FDA for this purpose and vancomycin, which is FDA approved for treating the infection.
Fidaxomicin is a macrocyclic antibiotic from a new class of antibiotics that targets a narrower range of ”bugs” and is minimally absorbed by the body.
In the study, 629 adults with symptoms of a C. diff infection and positive results on a stool toxin test were assigned either to take fidaxomicin, 200 milligrams twice a day, or vancomycin, 125 milligrams four times a day. The treatment continued for 10 days.
Researchers compared cure rates in each group. Cure was defined as the resolution of symptoms and no need for further treatment as of the second day after the end of the 10-day course of medicine.
Gorbach’s team also looked at recurrences during a four-week follow-up.
Four weeks is the typical time period in which a recurrence occurs, Gorbach tells WebMD. “We find most people have a recurrence within four weeks. In fact, most have it within two weeks.”
With each recurrence, he says, the chance of another recurrence goes up.
Who’s Most At Risk Of A Clostridium Difficile Infection
C. diff mostly affects people who:
- have been taking antibiotics that work against several types of bacteria or several different antibiotics at the same time, or those taking long-term antibiotics
- have had to stay in a healthcare setting, such as a hospital or care home, for a long time
- are over 65 years old
- have certain underlying conditions, including inflammatory bowel disease , cancer or kidney disease
- have a weakened immune system, which can be caused by a condition like diabetes or as a side effect of a treatment such as chemotherapy or steroid medicine
- are taking a medicine called a proton pump inhibitor to reduce the amount of stomach acid they produce
- have had surgery on their digestive system
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Clostridium Difficile Infection: Which Antibiotics Carry The Highest Risk Of C Diff
Colitis, or inflammation of the colon, can be caused by a bacteria known as Clostridiadifficile . It is found throughout nature, particularly in soil and is normally present in the colon, or large intestine. There it is usually kept in check by other bacteria. However, it but can overgrow when the good bacteria die off. Patients can develop C.difficile colitis when antibiotics used to treat infections kill these good bacteria, disturbing the normal balance of bacteria in the intestines. This can cause symptoms, like abdominal pain and diarrhea.
Antibiotics with the highest risk of causing C. diff infections:
- Cephalosporins, especially second and third generation:
- Lorabid
Prevention of C. difficile Infections:
The most effective way to prevent C. diff infections is to avoid unnecessary antibiotics. Remember, if your doctor does not want to prescribe you antibiotics, they do this not because they want to keep you from getting better, but they want to prevent harm.
Treatment of C. difficile Infections:
When C.difficile colitis develops it is treated with another antibiotic, Vancocin , or Flagyl . Vancomycin is taken orally in a dose of 125 mg four times a day for 10 days. Metronidazole is taken orally in a dose of 250 mg four times a day or 500 mg three times a day for 10 days.
Medication For Clostridium Difficile Infections
If you are taking antibiotics and have an infection with Clostridium difficile, your NYU Langone doctor discontinues the medication that triggered the infection, if possible. For people with mild antibiotic-associated diarrhea and no fever or abdominal pain, stopping antibiotics may be the only treatment necessary.
If discontinuing the antibiotics does not alleviate your symptoms, your doctor recommends another antibiotic to eliminate the original infection, as well as the diarrhea. Commonly prescribed medications include metronidazole, vancomycin, and fidaxomicin. Your doctor chooses the antibiotic based on the severity of your symptoms.
For people with a mild-to-moderate C. difficile infection, a doctor may prescribe metronidazole. Those with persistent symptoms or a recurrent C. difficile infection may be given vancomycin. Side effects of these medications include nausea, a bitter taste in the mouth, and abdominal pain.
C. difficile returns in about 20 percent of people treated with antibiotics because the initial infection never went away or the person was reinfected with a different strain of the bacterium. Symptoms such as diarrhea typically appear three days to three weeks after treatment is discontinued.
If a C. difficile infection returns after treatment, the infection is usually treated with the same antibiotic used the first time. If the infection recurs a second time, doctors prescribe either vancomycin or fidaxomicin.
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Symptoms Of C Difficile Colitis
Individuals with mild C. difficile colitis may have:
- a low-grade fever,
- mild diarrhea ,
- mild abdominal cramps and tenderness.
Those with severe C. difficile colitis may have:
- a high fever ,
- severe diarrhea with blood, and
- severe abdominal pain and tenderness.
Severe diarrhea also can lead to dehydration and disturbances in the electrolytes in the body. Rarely, severe colitis can lead to life-threatening complications such as megacolon , peritonitis , and perforation of the colon.
Why Are There Relapses Of Clostridium Difficile Colitis
Approximately 10% to 20% of successfully treated patients can experience a relapse of C. difficile colitis with recurrence of diarrhea, abdominal cramps, and abdominal pain. Relapses typically occur days or even weeks after treatment is stopped. Some patients may experience several relapses.
The most likely explanation for relapse is that the C. difficile has not been completely eradicated by the initial course of antibiotics. C. difficile in its active bacterial form is killed by either metronidazole or vancomycin, but the spores are resistant to killing. Several days after stopping antibiotics, the surviving spores transform into active bacterial forms which will multiply and produce toxins again.
Another reason for relapse is the body’s inadequate production of antibodies against bacterial toxins. Antibodies are proteins that the body produces to fight bacterial, viral, and parasitic infections, as well as to protect the body from the harmful effects of toxins. Therefore, adults who are capable of producing adequate antibodies against C. difficile toxins usually do not develop C. difficile colitis. Some adults who cannot produce these antibodies are susceptible to relapses.
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Cdc Promotes Improving Inpatient Antibiotic Prescribing To Reduce Drug Resistance And Increase Patient Safety
In a 2014 CDC analysis of data regarding antibiotic prescribing in hospitalized patients, Fridkin and colleagues estimated that a 30% reduction in the use of broad-spectrum antibiotics would result in a 26% reduction in CDIs. In addition, improvement in physician antibiotic prescribing habits from overuse and incorrect use would also help to reduce antibiotic resistance.
The authors recommended the following measures :
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Promptly initiate antibiotics for a presumed infection, but first obtain any recommended cultures.
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Document and specify the drug’s indication, dose, and expected duration of use in the patient’s medical chart.
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Reassess the patient within 48 hours based on test results and patient examination adjust the antibiotic regimen and/or the agent, or end the antibiotic treatment, as needed.
Managing Suspected Or Confirmed Clostridioides Difficile Infection
Assessment
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individual factors such as age, frailty or comorbidities that may affect the risk of complications or recurrence.
1.1.3 For people with suspected or confirmed C. difficile infection, review existing antibiotic treatment and stop it unless essential. If an antibiotic is still essential, consider changing to one with a lower risk of causing C. difficile infection.
1.1.4 For people with suspected or confirmed C. difficile infection, review the need to continue any treatment with:
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proton pump inhibitors
-
other medicines with gastrointestinal activity or adverse effects, such as laxatives
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medicines that may cause problems if people are dehydrated, such as non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin2 receptor antagonists and diuretics.
For a short explanation of why the committee made these recommendations, see the rationale section on assessment.
For more details, see the evidence review.
Treating suspected or confirmed C. difficile infection
1.1.5 For adults, offer an oral antibiotic to treat suspected or confirmed C. difficile infection . In the community, consider seeking prompt specialist advice from a microbiologist or infectious diseases specialist before starting treatment.
1.1.8 Manage fluid loss and symptoms associated with suspected or confirmed C. difficile infection as for acute gastroenteritis. Do not offer antimotility medicines such as loperamide.
Advice
Reassessment
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What Can Be Done To Prevent The Spread Of C Difficile
As with any infectious disease, frequent hand hygiene is the most effective way of preventing the transmission of healthcare associated infections. Hand washing with soap and water is important during C. difficile outbreaks and is one of the best defences against further spread of the bacteria.
If you do not have access to soap and water, frequent use of alcohol-based hand rubs is encouraged. Most healthcare facilities provide alcohol-based hand rubs at entrances. Be sure to use them, but be aware that they are less effective than washing with soap and water as they do not destroy C. difficile spores.
If you work in or visit a hospital or long-term healthcare facility, wash your hands often preferably with soap and water, especially after using the toilet. Gloves should be worn when caring for a patient with C. difficile infection or if in contact with his/her environment. Use a new pair of gloves when caring for each patient. Be sure to wash your hands with soap and water after removing your gloves.
When antibiotics are prescribed, follow your doctor, pharmacist, or healthcare provider’s instructions and the directions on the label. Keep taking the antibiotics as prescribed to kill all of the C. difficile bacteria.
If you have concerns about C. difficile and medication you are currently using, talk to your doctor, pharmacist, or healthcare provider.
What Is A C Difficile Infection
A C. difficile infection results from a type of bacteria called Clostridium difficile infecting your large intestine. C. difficile bacteria are common and can be found everywhere. These bacteria can be found in the air, in water, or on items such as door knobs, sinks, and countertops. Small amounts of C. difficile bacteria are even found in many people’s intestines.
If C. difficile bacteria in your intestines grow out of control, they can cause an infection. This can happen after a person takes antibiotics. Antibiotics are a type of medicine that fight infections caused by bacteria. When you take antibiotics, the normal bacteria in your intestines that help keep you healthy can also be killed. When this happens, bacteria such as C. difficile can grow out of control. When a person has CDI, chemicals called toxins produced by the C. difficile bacteria make him or her sick.
CDI affects about 500,000 people in the United States each year. CDI can be mild to severe. The most common symptoms of CDI include watery diarrhea and cramping in your belly. Some people with CDI can become very sick. In rare cases, severe CDI can be life threatening.
Symptoms of severe CDI may include:
- Having watery diarrhea often throughout the day and night
- Cramping and pain in your belly that may be severe
- Blood or pus in your bowel movements
- Tenderness in your belly
- Weight loss
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Starting A Different Antibiotic
People with more severe diarrhoea or inflammation of the colon will normally be given an antibiotic that is known to kill C. difficile. This is usually vancomycin or metronidazole. Symptoms then usually ease within 2-3 days. In severe cases, prompt treatment with vancomycin or metronidazole may ease any colitis and prevent perforation of the colon. A newer antibiotic, called fidaxomicin, has been found to be useful particularly to treat people who have had more than one bout of C. difficile infection. However, further research is needed.
