c dif diarrhea

Welcome block 4!

Today we talked about a case of acute non bloody diarrhea, that turned out to be recurrent cdif. 

Here is a review of acute contagious diarrhea

We focused on the treatment of c dif which is as follows:

First Episode

***If possible stop offending antibiotics***

IF: Mild/Moderate Disease --> Metronidazole OR Vancomycin (PO) duration 10-14d

IF: Severe Disease ( Defined as:   Two of (Age above 60, Febrile, WBC above 15, Albumin below 25)   OR hypotension/shock or Cr greater than 1.5x normal, or toxic megacolon, peritoneal signs, perforated bowel)

consider- Infectious Disease +/- General Surgery Consultation

 Vancomycin (PO) unless severe illeus/toxic megacolon, then vanco PR and Metronidazole (IV) duration 10-14d (Vanco has more rapid symptom resolution and a lower risk of treatment failure).

Relapse

•   First relapse --> can repeat last treatment depending on severity

•   Second relapse --> vancomycin taper. ID consult.

New drug:  Fidaxomicin .. expensive, but targeted bactericidal drug.

Here is a review on C DIF from NEJM. and HERE is an article form annals thats good too. 

Here is the small study that gives hope to probiotics.