Treatments

Treating C  diff.  is becoming more challenging to physicians, frustrating to patients, and costly to the health care industry.

To date there are three antibiotics effective at treating C diff:

Metronidazole is prescribed to treat mild to moderate symptoms and is cost effective (8).  Vancomycin is prescribed for moderate to severe symptoms via: oral route as intravenous administration does not achieve gut lumen therapeutic levels. Vancomycin is prescribed to patients with unsuccessful results from the Metronidazole, or the patient is allergic, or pregnant, breastfeeding, or younger than ten years of age.

The most recent antibiotic, Dificid (fidaxomicin) www.dificid.com is the first medication approved by FDA to treat C diff. Associated-Diarrhea CDAD in more than twenty five years with superiority in sustained clinical response (5)

Organizations In Clinical Trials focused on C. difficile prevention, and treatments including recurrent C. diff. infections.  Click on the following link to be redirected to the Clinical Trials Page:

https://cdifffoundation.org/clinical-trials-2/

 

Loperamide (Immodium), diphenoxylate and bismuth medications are contraindicated as they slow the fecal transit time which extends the toxins in the gastrointestinal system.  The use of Cholestyramine has demonstrated positive results as toxins A and B bind to the resin as it passes through the intestines aiding in slowing bowel motility and assists in decreasing dehydration (9).  ** Always discuss symptoms and treatments with the physician/s treating this infection.

The use of probiotics during treatment and prophylactic may decrease diarrhea by interrupting either of the potential mechanisms; by maintaining the flora of the gut and ongoing carbohydrate fermentation; and/or by competitively inhibiting the growth of pathogens (6).

The latest treatment for patients with CDI (CDAD) is the fecal microbiota transplant (FMT) and aka stool transplant preliminarily been effective in curing C diff. This procedure is not FDA approved and is a hopeful treatment.

**  Treatment to Reduce Recurrent C. difficile infections In Patients 18 Yeas Of Age And Older:

On October 22, 2016 announced that the U.S. Food and Drug Administration (FDA) has approved ZINPLAVA™ (bezlotoxumab) Injection 25 mg/mL.

Merck anticipates making ZINPLAVA available in first quarter 2017.

ZINPLAVA is indicated to reduce recurrence of Clostridium difficile infection (CDI) in patients 18 years of age or older who are receiving antibacterial drug treatment of CDI and are at high risk for CDI recurrence.

ZINPLAVA is not indicated for the treatment of CDI.

ZINPLAVA is not an antibacterial drug. ZINPLAVA should only be used in conjunction with antibacterial drug treatment of CDI.

Please see Prescribing Information for ZINPLAVA (bezlotoxumab) at http://www.merck.com/product/usa/pi_circulars/z/zinplava/zinplava_pi.pdf 

Patient Information for ZINPLAVA at http://www.merck.com/product/usa/pi_circulars/z/zinplava/zinplava_ppi.pdf

 

Since  November 2012, the  CDC has been sharing public announcement regarding antibiotic use;   Colds and many ear and sinus infections are causes by viruses, not bacteria. Taking antibiotics to treat a virus can make those drugs less effective when you and your family really need them (7).  Limiting the usage of antibiotics will also help limit new cases of CDI.

C.diff. spores are able to live outside of the body for a very long period of time and are resistant to most routine cleaning agents.

It has also been proven that alcohol based hand sanitizers remain ineffective in eradicating C. diff. spores.  In 2009 Clorox Commercial Solutions Ultra Clorox Germicidal Bleach ® was named the first and only product to obtain Federal EPA registration for killing C. diff. spores on hard, non porous surfaces when used as directed (1).  The CDC also recommends a 1:10 ( 1 cup bleach to 9 cups of water) dilution of bleach and water for cleaning hard non-porous surfaces keeping areas covered with solution for 10 minutes and the solution is to be mixed fresh daily.

Hand hygiene remains #1 in Infection Prevention.

Following guidelines in infection control; it is important to wash hands upon entering and before exiting a patient’s room (4). The spores are difficult to remove from hands; Universal Contact Precautions remain best practice for healthcare personnel and Contact Precautions for patients with a confirmed diagnosis of CDI. Prevention through education about CDI has proven effective and beneficial to environmental housekeeping departments, health care professionals, administration, patients, and their families (2)

For More Information On Hand Washing Click On The Following Link:

https://cdifffoundation.org/hand-washing-updates/

 

References:

(1) Clorox registered EPA
http://www.ahe.org/ahe/learn/press-releases/2009/20090402_clorox_epa_cdiff.shtml

(2) Clostridium difficile (CDI) Infections thttp://www.cdc.gov/hai/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf
(3) Lab Tests and Diagnosis Mayo Clinichttp://www.mayoclinic.com/health/c-difficile/DS00736/DSECTION=tests-and-diagnosis
(4) CDC Hand washing
http://www.cdc.gov/Features/HandWashing/

(5) FDA announcement Dificid
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm257024.htm

(5) Dificid.com
http://www.dificid.com

(6) Probiotics in the prevention of antibiotic-associated diarrhea
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105609/

(6) Danimals PRNewswire8/Jan2012;
http://www.prnewswire.com/news-releases/dannonr-danimalsr-adds-proven-benefits-of-probiotics-53347947.html

(7) Get smart antibiotics week CDC
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a7.htm

(8) Metronidazole
http://www.everydayhealth.com/drugs/flagyl

(9) Cholestyranine
http://www.globalrph.com/cholestyramine.htm