What Is The Best Antibiotic To Treat C Diff

What Causes Clostridioidesdifficile

When a person takes antibiotics, the good germs in the intestines are killed off making it easier to become infected by the Clostridioidesdifficile germ. The germ is found in stool , and is spread to other people by unwashed hands, contaminated surfaces, or objects.

In a healthcare setting, the germs have been found on objects such as toilets, bathroom fixtures, bed rails, and rectal thermometers. The germ is able to survive for a very long time on a variety of surfaces.

Gut Dysbiosis And Antibiotic Usage

Your body is full of colonies of microorganisms, referred to as your microbiome. There are billions of beneficial bacteria living in your gut that have positive effects on your health. They support your digestion, immune function, brain and neurological health, and other functions.

Having a good microbiome balance with more beneficial bacteria than harmful bacteria and pathogens is critical for your health. When the bacterial colonies in your microbiome become out of balance, and you have too many bad bugs, you can develop gut dysbiosis. Gut dysbiosis refers to an imbalance in your gastrointestinal tract). It can lead to digestive problems and an array of non-gut symptoms, including headaches, fatigue, brain fog, and poor immunity.

There are a number of factors that can increase your risk of developing gut dysbiosis, including dietary and lifestyle choices. One of the main contributing factors that can lead to gut dysbiosis is antibiotic use. Antibiotics are designed to tackle bacterial infections. While they do a good job at killing bad bacteria, antibiotics also kill beneficial bacteria. Yes, they wipe out the good guys as well.

A 2013 study published in Therapeutic Advances in Gastroenterology has found a connection between gut dysbiosis and C. diff . According to the study, gut dysbiosis increases the risk of gut infections, particularly the risk of a C. diff infection which may contribute to the development of inflammatory bowel disease .

Is Yogurt Good For C Diff

Probiotics: Probiotics are friendly, live bacteria you need to combat the C. diff germ. They can be found in active yogurt cultures and in fermented foods, such as sauerkraut and miso. Probiotics help to reduce or eliminate watery diarrhea by putting good bacteria back into the gastrointestinal tract.

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Antibiotic Therapy For Clostridium Difficile

Background

Clostridium difficile is a bacterium that can live harmlessly in the colon, but when an individual takes an antibiotic for another condition, the C. difficile can grow and replace most of the normal bacterial flora that live in the colon. This overgrowth causes C. difficile-associated diarrhoea . The symptoms of CDI include diarrhoea, fever and pain. CDI may be only mild but in many cases is very serious and, if untreated, can be fatal. There are many proposed treatments for CDI, but the most common are withdrawing the antibiotic that caused the CDI and prescribing an antibiotic that kills the bacterium. Many antibiotics have been tested in clinical trials for effectiveness and this review studies the comparisons of these antibiotics. This review is an update of a previously published Cochrane review.

Methods

We searched the medical literature up to 26 January 2017. All randomised trials that compare two different antibiotics, or variations in dosing of a single antibiotic for treatment of CDI were included. Trials comparing antibiotic to placebo or no treatment were sought but, save for one poor quality placebo-controlled trial, none were found. Trials that compared antibiotics to a non-antibiotic treatment were not included.

Results

Clostridium difficile is recognized as a frequent cause of antibiotic-associated diarrhoea and colitis. This review is an update of a previously published Cochrane review.

What Do I Do After Returning Home From The Hospital

You can return to your normal routine once you are back at home. The diarrhea is often better or gone before you go home, which makes the spread of Clostridioides difficile to others much less likely.

You can lower the chances of developing Clostridioides difficile infection again or spreading it to others. For example:

• Take your medication to treat Clostridioides difficile exactly as instructed by your healthcare provider and pharmacist. Take all the medication as directed. Do not take half-doses or stop before you have taken all the medicine.
• You and your family members should wash their hands after going to the bathroom, before preparing or eating food, and when hands are dirty.
• Clean surfaces in bathrooms and kitchens regularly with household detergents/disinfectants.
• Tell your healthcare provider if your diarrhea returns.

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Best Diet To Prevent Recurring Pseudomembranous Colitis

Not much research has looked at whether particular foods or diets can prevent pseudomembranous colitis.

However, theres one interesting study that looked at the effects of drinking kefir.

Patients being treated for recurring pseudomembranous colitis who drank at least five ounces of kefir three times a day for at least two months were more likely to remain free of diarrhea during the following nine months than those who didnt.

This success rate is equal to that of fecal microbiota transplantation, currently the most successful treatment option for recurring pseudomembranous colitis .

Foods that contain probiotics , like kefir, are known to beneficially impact gut health as well as overall health. Its possible they may also help stop C. diff recurrences.

Yogurt, quark, sauerkraut, tempeh and miso may all contain probiotics. Check the packaging of these foods to make sure that they contain live active cultures.

What Is C Diff Disease

C. diff occurs when antibiotics kill your good bowel bacteria and allow the C. diff to grow. When C. diff grows, it produces toxins. These toxins can damage the bowel and may cause diarrhea. C. diff disease is usually mild but sometimes can be severe. In severe cases, surgery may be needed, and in extreme cases C. diff may cause death. C. diff is the most common cause of infectious diarrhea in hospitals or long-term care homes.

The main symptoms of C. diff disease are :

• Watery diarrhea

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Tetracycline Use And Cdi Occurrence

A total of 5322 CDI cases and 412208 controls were included . Metaanalysis of all 6 studies using the random-effects model with adjusted ORs demonstrated that tetracyclines were associated with a decreased risk of CDI compared with other antibiotics . There was significant heterogeneity among the studies, with an I2 of 53%. No publication bias was seen .

Analysis of all included studies. A, Forest plot demonstrating decreased odds of Clostridium difficile infection with tetracycline use by the random-effects model. B, Funnel plot demonstrating no publication bias. Abbreviations: CI, confidence interval df, degrees of freedom IV, inverse variance SE, standard error.

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Why It Is Important To Do This Review

During the early part of the 21st century, much higher mortality rates from CDI than previous reports were reported in Quebec . This was related to the appearance of a new variant of C. difficile, which is capable of secreting much higher amounts of toxin A and B and is more resistant to standard antibiotic therapy . This new variant resulted in a higher incidence of CDI among hospitalised patients , a greater need for urgent colectomy for toxic colitis and a high mortality rate . This variant, ribotype 027, has spread from Quebec to the USA, and Europe . In the United States hospitalizations for CDI doubled between 2000 and 2010 and was expected to continue to increase in 2011 and 2012. CDI is the leading cause of gastrointestinalrelated death in the USA. CDI is estimated to have caused 14,000 deaths in the USA in 2007 and is the most common healthcareassociated infection. The estimated cost of CDI is USD 4,800 million per year for acute care facilities alone in the USA . Unlike the UK, where both incidence and mortality have declined in recent years , the Agency for Healthcare Research and Quality has shown a consistent increase in CDI from the turn of the century through 2015 .

The emergence of this highly virulent bacterium adds urgency to the identification of effective therapy.

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Antimicrobial Stewardship Efforts To Prevent And Control Cdi Outbreaks

Evidence from several studies suggests that changes in antimicrobial prescribing practices in hospitals can affect the incidence of HCF-acquired non-BI/NAP1 CDI . Two studies described interventions in which clindamycin use was restricted as a means to control CDI outbreaks. In both studies, clindamycin use was associated with increases in the incidence of CDI. The high CDI incidence persisted despite increased use of infection control measures but decreased with the restriction of clindamycin use . For reasons explained previously in this article, clindamycin exposure appears to be unique, at least in animal models, resulting in a longer window of susceptibility to CDI thus, the results from these formulary intervention studies may not be readily generalizable to other antimicrobials.

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Managing Suspected Or Confirmed Clostridioides Difficile Infection

Assessment

• the severity of C. difficile infection

• 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:

• proton pump inhibitors

• other medicines with gastrointestinal activity or adverse effects, such as laxatives

• 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

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Treatments For A C Diff Infection

If a doctor thinks you have a C. diff infection, they may ask for a sample of your poo to be tested.

The infection can sometimes be treated at home, or you might need to go into hospital. This is because C. diff infections can sometimes lead to more serious problems like .

A C. diff infection is treated by:

• stopping any antibiotics you’re taking, if possible
• taking a 10-day course of another antibiotic that can treat the C. diff infection

You’ll also be given advice about how to avoid dehydration, such as making sure you drink plenty of water.

Your symptoms should improve a few days after starting the new course of antibiotics. But it may be 1 to 2 weeks before the infection clears up completely.

Go back to see the GP if your symptoms get worse, you feel very unwell after starting the antibiotics, or your symptoms come back afterwards.

If your symptoms return, treatment may need to be repeated.

Is It Time To Get A New Probiotic For C Diff

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Looking After Yourself At Home

If youre well enough to recover from Clostridium difficile at home, the following measures can help relieve your symptoms and prevent the infection spreading:

• make sure you finish the entire course of any antibiotics youre prescribed, even if youre feeling better
• drink plenty of fluids to avoid dehydration and eat plain foods, such as soup, rice, pasta and bread, if you feel hungry
• take paracetamol for tummy pain or a fever
• do not take anti-diarrhoeal medicine, as this can stop the infection being cleared from your body
• regularly wash your hands and contaminated surfaces, objects or sheets
• stay at home until at least 48 hours after your last episode of diarrhoea

Your GP may contact you regularly to make sure youre getting better. Call them if your symptoms return after treatment finishes, as it may need to be repeated.

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Risk Factors For Contracting C Difficile Infection

People who are in hospitals or other healthcare settings are at highest risk of developing C. difficile infections. Other people are those who:

• Have serious illnesses, particularly those that can weaken the immune system
• Are taking or who have recently taken antibiotics
• Are taking medications to manage stomach acid, including those known as proton pump inhibitors
• Have had previous C. difficile infections.

The only way to prevent developing an infection with C. difficile is by avoiding exposure to the bacteria. The most effective method to do this is by frequent and proper hand washing with soap and water by everyone, patients, visitors, and anyone who works in the healthcare facilities. Waterless hand cleaners do not adequately kill C. difficile.

Patients who have C. difficile infection should be isolated from other patients to avoid spreading the bacteria. Healthcare workers who enter isolation rooms have to wear gloves and gowns. Reducing antibiotic overuse also reduces the risk of C. difficile infection. This means not asking for antibiotics for viral infections and not taking someone elses medications.

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Treatment Of Severe Clostridium Difficileassociated Disease

Of patients with C. difficile infection, 38% develop fulminant colitis.14 Markers of disease severity include ileus, renal insufficiency, colon wall thickening on computed tomography imaging, and endoscopic visualization of pseudomembranes, as well as the usual signs of septic physiology: fever, significant leukocytosis, hypotension requiring fluid resuscitation, and tachypnea. These markers may portend toxic megacolon, imminent intestinal perforation, or fulminant colitis, and they may predict a significantly higher risk of colectomy or death. Empiric therapy should be started for ill patients as soon as C. difficile is suspected, to avoid any delay related to obtaining the results of stool or equivocal examinations. As stool examinations are imperfect, clinical judgment is still vital.

Although studies are lacking, the consensus is that antimotility agents should not be used for CDAD, even if the CDAD is mild in severity. Continuation of the inciting antibiotic may also contribute to treatment failures. An observational study by Modena and colleagues demonstrated that in a small series of patients prescribed metronidazole for symptomatic CDAD, cure was achieved in 100% of patients whose causative antibiotics were stopped, but in only 59% of patients in whom antibiotics were continued .20

The Newest Treatment Strategy For Clostridium Difficile: Worth A Look

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In the world of emerging, resistant pathogens, Clostridiumdifficile is quickly rising to the top of the more difficult infectiousdiseases to treat. C. difficile is a gram-positive, anaerobicspore-forming organism that attacks the colonic epithelium and causes celldeath.

This can result in C. difficile-associated diarrhea,pseudomembranous colitis, toxic megacolon and death. In the current times ofimprudent use of antimicrobials, C. difficile prevalence is increasing,drug resistance and treatment failures are more notable and a potentiallyepidemic strain has been isolated. It is inevitable thattreatment strategies must be scrutinized, alternative agents considered,antimicrobial stewardship must take precedence and infection preventionmeasured employed.

The Society for Healthcare Epidemiology of America and InfectiousDiseases Society of America last published treatment guidelines for C.difficile in 1995.

Other agents

Fidaxomicin was studied in two phase 2 trials conducted by Louie andcolleagues. The first trial evaluated 50-, 100-, and 200-mg doses orally every12 hours for 10 days. The study also evaluated suppression of C.difficile quantitative counts, recrudence of C. difficile vegetativeand/or spore counts after therapy, re-expression of cytotoxin B in fecalfiltrates after treatment and quantitative counts of Bacteroides speciesas a marker of normal flora.

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C Diff Infection Treatment

If you were taking an antibiotic when your symptoms started, your doctor will probably ask you to stop taking it. They will watch you for dehydration if you have severe diarrhea. About 25% of patients begin to improve 2 to 3 days after they stop the antibiotic that caused the infection.

For severe cases, your doctor may prescribe a 10-day dose of an antibiotic that has proved effective in treating C. diff. infections. Examples include metronidazole and vancomycin. You should improve after 72 hours of starting the medicine, although the diarrhea may continue. In about 15% to 35% of cases, a second round of antibiotics is needed.

While you recover, drink plenty of fluids to replace what your body lost due to diarrhea. Avoid milk products and foods that contain wheat flour or are high in fiber. Your digestive tract may be sensitive to them for a few days.

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Faqs For Clinicians About C Diff

• What can I use to clean and disinfect surfaces and devices?

C. diff

C. diff is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea and accounts for 15 to 25% of all episodes of AAD.

C. diff

• pseudomembranous colitis

• watery diarrhea

The risk for disease increases in patients with:

• antibiotic exposure
• gastrointestinal surgery/manipulation
• long length of stay in healthcare settings
• a serious underlying illness

• Colonization with C. diff is more common than infection. Colonized patients do not have disease caused by C. diff and often exhibit NO clinical symptoms of infection colonized patients do test positive for the C. diff organism or its toxin.

  Patients with infection exhibit clinical symptoms and test positive for the C. diff organism or its toxin.

See Figure 2 in the 2017 IDSA/SHEA Clinical Practice Guidelinesexternal icon

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