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Optimer Pharmaceuticals, AŞ Message Board

  • roozbehbadii roozbehbadii Nov 20, 2011 11:17 PM Flag

    from Epocrates regarding C.Diff

    Antibiotic therapy

    In the past, diarrhea was expected to resolve in 15% to 30% of patients with conservative therapy alone, while presumptive antibiotic treatment was reserved for patients with a high index of suspicion for pseudomembranous colitis who were particularly ill. [1] With the recent emergence of the epidemic strain (BI/NAP1), rapid clinical deterioration is more likely and prompt treatment should be instituted.

    Metronidazole should be started presumptively in all patients with mild-to-moderate disease unless they have a contraindication to its use or are pregnant. image If the patient cannot be given metronidazole or has not responded to metronidazole within 7 days, vancomycin therapy should be initiated. [8]

    In patients who have more severe disease, vancomycin should be started presumptively first line, because it has been shown to be more effective than metronidazole. Routine use of oral vancomycin as a first-line agent is discouraged by the CDC to avoid emergence of nosocomial vancomycin-resistant enterococci and staphylococci unless the patient has severe disease or is pregnant. Surgery may be considered for severe disease. [1]

    Fulminant disease is associated with a 24% to 38% mortality rate. In these patients, vancomycin can be administered by retention enema or nasogastric tube, and metronidazole can be administered intravenously if necessary. The 2 agents should be administered simultaneously. Surgery may be warranted in patients who do not respond to antibiotic therapy. [16]
    Treatment relapse

    Approximately 5% to 20% of patients treated with either metronidazole or vancomycin will have a recurrence after discontinuation of therapy. [9] Most will respond to a second course of the initial therapy. However, patients with a first recurrence have a rate of second recurrence that may be as high as 33%. [8] Patients with multiple recurrences are usually treated with prolonged tapering or pulsed doses of oral vancomycin, although this therapy has not been proven to be effective.