Clostridium difficile associated disease (CDAD) is one of the most common nosocomial infections.Treatment of CDAD has not changed much over the last 10 years except we see more of them in our practice. I have outlined the treatment protocol for a non severe infection.
Metronidazole should be used for initial treatment of non-severe CDAD. The recommended dose is 500 mg three times daily or 250 mg four times daily. As discussed below, intravenous metronidazole at a dose of 500 mg every eight hours may also be used for treatment of CDAD. Fecal concentrations in the therapeutic range are achievable with this regimen because of the drug's biliary excretion and increased exudation across the intestinal mucosa during CDAD.
If oral vancomycin is used, the recommended dose is 125 mg four times daily. Oral vancomycin is not absorbed systemically and achieves predictably high levels in the colon. Dosing regimens of 125 mg four times daily and 500 mg four times daily are equally effective for the treatment of CDAD. Intravenous vancomycin has no effect on C. difficile colitis since the antibiotic is not excreted appreciably into the colon.
Duration of therapy — The standard duration of initial antibiotic therapy for non-severe C. difficile diarrhea is 10 to 14 days. Patients with an underlying infection requiring prolonged duration of antibiotics should continue CDAD treatment throughout the antibiotic course plus one additional week after its completion.
Repeat stool toxin assays are NOT warranted following treatment. Up to 50 percent of patients have positive stool assays for as long as six weeks after the completion of therapy. Read full article here..
Metronidazole should be used for initial treatment of non-severe CDAD. The recommended dose is 500 mg three times daily or 250 mg four times daily. As discussed below, intravenous metronidazole at a dose of 500 mg every eight hours may also be used for treatment of CDAD. Fecal concentrations in the therapeutic range are achievable with this regimen because of the drug's biliary excretion and increased exudation across the intestinal mucosa during CDAD.
If oral vancomycin is used, the recommended dose is 125 mg four times daily. Oral vancomycin is not absorbed systemically and achieves predictably high levels in the colon. Dosing regimens of 125 mg four times daily and 500 mg four times daily are equally effective for the treatment of CDAD. Intravenous vancomycin has no effect on C. difficile colitis since the antibiotic is not excreted appreciably into the colon.
Duration of therapy — The standard duration of initial antibiotic therapy for non-severe C. difficile diarrhea is 10 to 14 days. Patients with an underlying infection requiring prolonged duration of antibiotics should continue CDAD treatment throughout the antibiotic course plus one additional week after its completion.
Repeat stool toxin assays are NOT warranted following treatment. Up to 50 percent of patients have positive stool assays for as long as six weeks after the completion of therapy. Read full article here..
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