Materiały źródłowe

• #1 Pseudomembranous Colitis Surgery Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/193031-treatment

  Pseudomembranous colitis usually is associated with antibiotic use. In mild or moderate cases, supportive therapy alone is sufficient. Such therapy includes the following: Discontinuing or changing the offending antibiotics, avoiding narcotics and antidiarrheal agents, maintaining fluid and electrolyte intake, employing enteric isolation. […] In fulminant or intractable cases, hospitalization for intravenous (IV) hydration will be necessary. Two thirds of patients with toxic megacolon require surgical intervention. […] Therapeutic strategies to inhibit toxin Ainduced colitis are being tested. 5-Aminosalicylic acid (ASA) is an area of interest. […] In mild or moderate cases of pseudomembranous colitis, supportive therapy alone is sufficient. This includes discontinuing or changing the offending antibiotics, avoiding narcotics and antidiarrheal agents, maintaining fluid and electrolyte intake, and enteric isolation. Most patients75% of symptomatic patients and 25% of patients with colitiswill experience complete recovery within 10 days. In fulminant or intractable cases, hospitalization for IV hydration will be necessary.

• #1 Pseudomembranous Colitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pseudomembranous-colitis

  Management of pseudomembranous colitis includes correcting fluid losses or electrolyte imbalance with oral or intravenous (IV) electrolyte solutions. […] Avoid antiperistaltic agents such as loperamide or opiates (codeine) because of the risk of retention of toxins in the lumen. […] Ceasing the causative antibiotic (if possible) allows resolution in ~3 days in 22%. Consider changing to an antibiotic less likely to cause PMC – for example, aminoglycosides, macrolides, vancomycin or tetracyclines. […] The National Institute for Health and Care Excellence (NICE) recommends the following antibiotics for adults aged 18 years and over: First-line antibiotic for a first episode of mild, moderate or severe C. difficile infection: Vancomycin: 125 mg orally four times a day for 10 days. […] Second-line antibiotic for a first episode of mild, moderate or severe C. difficile infection if vancomycin is ineffective: Fidaxomicin: 200 mg orally twice a day for 10 days.

• #1 Pseudomembranous Colitis – The Gastrointestinalatlas – gastrointestinalatlas.com

  https://www.gastrointestinalatlas.com/english/pseudomembranous_colitis.html

  As soon as pseudomembranous colitis is suspected, the implicated antibacterial should be withdrawn, symptomatic treatment of diarrhea started and specific antibacterial therapy initiated. The diagnosis can be confirmed by the isolation of C. difficile or its toxins in stool. […] Therapy for PMC includes discontinuation of implicated antimicrobial agents, administration of antimicrobial agents directed against C. difficile, and supportive measures. Diarrhea will resolve without specific antimicrobial therapy in 15% to 25% of patients. Supportive measures include intravenous (IV) fluids to correct dehydration and electrolyte imbalance. Nutritional support may be required to correct hypoalbuminemia. Antiperistaltic agents should be avoided because they may delay clearance of toxins from the colon, leading to increased colonic injury, ileus, and toxic dilation.

• #1 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  The decision to treat C difficile infection (CDI) and the type of therapy administered depend on the severity of infection, as well as the local epidemiology and type of C difficile strains present. Except for perioperative prophylaxis, it is recommended that the use of cephalosporin and clindamycin be restricted for infection prevention. No treatment is necessary for asymptomatic carriers. […] For symptomatic patients, the Infectious Diseases Society of America (ISDA) and Society for Healthcare Epidemiology of America (SHEA) 2021 updated guideline for CDI treatment recommend administering fidaxomicin for initial and recurrent infections, with oral vancomycin as an alternative. Fecal microbiota transplantation (FMT) may also be added after treating the second recurrence. Bezlotoxumab had been recommended as adjunctive treatment for recurrent CDI, but it has been discontinued as of January 31, 2025.

• #1 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  In patients with severe, complicated, or fulminant CDI (hypotension, shock, ileus or megacolon), oral (or via nasogastric tube) vancomycin 500 mg every 6 hours along with intravenous (IV) metronidazole is recommended. Rectal vancomycin may also be added in patients with ileus. […] Treatment recommendations for CDI have evolved over the past few years. One reason for change is the frequent relapse rate of CDI (20-27%). In 2021, the ISDA recommended using fidaxomicin first line for treatment of an initial CDI episode as well as subsequent recurrence. Relative to vancomycin, fidaxomicin is not only a more targeted intestinal antibiotic but also associated with fewer CDI recurrences. Vancomycin is still considered to be an acceptable alternative. However, metronidazole is no longer recommended unless fidaxomicin and vancomycin are not available.

• #1 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. […] As most patients with pseudomembranous colitis have C difficile infection, it should be excluded first. Empiric treatment for C difficile should be started if the patient is seriously ill. […] These less common causes are important to consider to avoid needlessly escalating anti-C difficile antibiotic therapy and to provide appropriate treatment. […] If testing for C difficile is positive, treatment is generally based on the severity and the complications of the illness: Mild or moderate C difficile infection should be treated with oral metronidazole 500 mg three times per day for 10 to 14 days.

• #1 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  Second recurrence or subsequent recurrences: Treatment recommendations are the same as that for the first recurrence, but consideration for FMT is also recommended after treatment of the second recurrence. […] Fulminant (hypotension or shock, ileus, or megacolon) CDI: Vancomycin 500 mg every 6 hours by mouth or nasogastric tube, combined with IV metronidazole 500 mg every 8 hours. In patients with ileus, consider adding rectal vancomycin 500 mg every 6 hours in 100 mL normal saline as a retention enema. […] In patients with suspected severe (WBC count 15,000 cells/uL and creatinine level 1.5mg/dL) or fulminant CDI, initiate early empirical therapy while the stool tests are pending. […] In a multicenter retrospective (2013-2014) study of CDI in 72 Spanish patients, fidaxomicin treatment was effective and well tolerated in patients with severe CDI as well as those at high risk of recurrent disease. The clinical cure rate was 90.3%, with a 16.7% recurrence and a 72.2% sustained cure.

• #1 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  Initial treatment: Treatment with fidaxomicin 200 mg by mouth twice a day for 10 days. If fidaxomicin is not available, then use oral vancomycin 125 mg by mouth four times a day for 10 days as an alternative. In nonsevere CDI (white blood cell [WBC] count 15,000 cells/uL and creatinine level 1.5 mg/dL), if fidaxomicin and vancomycin are not available, then use metronidazole 500 mg every 8 hours for 10-14 days. […] The FDA approved fidaxomicin for children aged 6 months or older in January 2020 for treatment of C difficile-associated diarrhea (CDAD). Approval was based on the phase 3 SUNSHINE clinical trial that included 148 randomized patients younger than 18 years with confirmed CDI, of whom 142 received either fidaxomicin or vancomycin in a 2:1 ratio. […] First recurrence: Fidaxomicin 200 mg by mouth twice a day for 10 days or a pulsed regimen. Alternative treatment: Vancomycin tapered or pulsed regimen may be considered with recurrent infection.

• #1 10. The Management Of Pseudomembranous Colitis | PPT

  https://www.slideshare.net/slideshow/10-the-management-of-pseudomembranous-colitis/1571907

  Metronidazole Effective (response rate 86-90%) and inexpensive Antibiotic against various anaerobes and protozoa Oral dose 250mg qid for 7-10 days Relapse rate 8-9% of cases Contraindication: Children below 10yrs and women during pregnancy. […] Vancomycin Most reliable treatment (response rate 90-100%) Poorly absorbed (less side effects) There is risk of developing vancomycin-resistant enterococci Oral dose 125mg qid for 7-10 days In the setting of ileus, higher dose 500mg qid for 7-10 days to deliver adequate doses. […] Relapses Not commonly associated with resistance to metronidazole Mostly occur 3-10 days after discontinuation of treatment Should be treated with second course of metronidazole Some authors report success in preventing relapses with tapering regimen of vancomycin given daily or every other day for 1-2 months.

• #1 10. The Management Of Pseudomembranous Colitis | PPT

  https://www.slideshare.net/slideshow/10-the-management-of-pseudomembranous-colitis/1571907

  For patients who do not respond to either regimen of metronidazole or vancomycin combination of vancomycin and rifampicin sometimes beneficial. […] Surgical Intervention Indicated for patients who are complicated with toxic megacolon with existing or subsequent risk of perforation Frequency is low (0.39 3.6%) Diverting ileostomy or subtotal colectomy. […] Overall mortality rate for patients requiring surgery is 30-35%.

• #1 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  In fulminant cases, combined therapy with IV metronidazole and vancomycin (PO or PR) is the treatment of choice. IV vancomycin is ineffective and should not be used for C difficile. […] FMT is a novel therapy that involves the transfer of stool from a healthy donor to a patient with CDI to reconstitute the normal colonic microbial flora. It is given after treating CDI with antibiotics. Studies have evaluated prevention of recurrence of CDI after FMT. […] Several studies have shown that FMT by colonoscopy or enema was an effective approach for patients with recurrent CDI, with clinical success rates of up to 95%. […] In the first randomized, controlled trial of FMT, investigators in The Netherlands found fecal transfer to be 3 times more effective than antibiotics in curing recurrent CDI, leading to the study’s early termination.

• #1 Pseudomembranous colitis

  https://www.mymlc.com/health-information/diseases-and-conditions/p/pseudomembranous-colitis/

  Treatment options may include: […] Repeat antibiotics. You may need a second or third round of antibiotics to resolve your condition and may need a longer duration of therapy. […] Surgery. Surgery may be an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall (peritonitis). Surgery has typically involved removing all or part of the colon (total or subtotal colectomy). […] A newer surgery that involves laparoscopically creating a loop of colon and cleaning it (loop ileostomy and colonic lavage) is less invasive and has had positive results. […] Fecal microbial transplantation (FMT). FMT is used to treat recurrent pseudomembranous colitis. You’ll receive healthy, cleaned stool in a capsule, nasogastrically or inserted into your colon.

• #1

  http://www.tropicalgastro.com/printerfriendly.aspx?id=1933

  Starting from day 7, she received FMT once in every 5 days for a total of 4 times. […] The sigmoidoscopic picture started improving after first FMT itself and there was complete healing of the lesions after the fourth FMT. […] Treatment of CDI depends on the grade of severity. […] The recommended treatment for mild disease is oral metronidazole, for moderate disease is oral vancomycin, for severe disease is oral vancomycin and IV metronidazole and for complicated disease is the above treatment with or without surgery. […] However, newer guidelines advocate FMT for severe refractory CDI even during the first episode. […] In our case, as the disease was severe and not responding to the standard line of management, we decided to use FMT. […] The principle of FMT is bacterial interference by restoration of missing components of the bacterial flora and replacing pathogenic organisms.

• #1

  http://www.tropicalgastro.com/printerfriendly.aspx?id=1933

  Our patient was a 30 year-old female, who was a diagnosed case of tubercular meningitis (TBM) and was on anti-tubercular treatment (ATT) for 5 days before she came to us. […] She was diagnosed with Clostridium difficile (C. difficile) pseudomembranous colitis following a sigmoidoscopy and a positive stool test for C. difficile toxin. […] She was started on IV metronidazole and oral vancomycin which was up-titrated to 500 mg every six hours. […] Given the severity and refractoriness to the standard antibiotics, a decision to perform fecal microbial transplantation (FMT) was taken on day 6. […] After negative stool and serological testing for coexisting infections and after fulfilling the donor inclusion and exclusion criteria, 50 g of freshly passed stool was taken from her husband and homogenized in 300 ml of 0.9% normal saline (NS) with a blender to achieve a liquid slurry which was filtered to remove particulate matter.

• #1 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  In a retrospective study of 83 immunocompromised patients who underwent FMT for recurrent (12%), refractory (54%), or severe (34%) CDI, the cure rate after a single transplant was 79% (52 of the 66 patients with 12 weeks of follow-up). […] In November 2022, the FDA approved microbiota via rectal administration (Rebyota) for prevention of recurrence of CDI in adults following antibiotic treatment for CD recurrence. […] A second orally administered microbiota product (Vowst) received FDA approval in April 2023. Results from the ECOSPOR III phase 3 double-blind, randomized, placebo-controlled trial showed a decreased recurrence of CDI in patients treated orally with microbiota compared with placebo (12% vs 40%, respectively; P 0.001).

• #1 Pseudomembranous colitis

  https://www.mymlc.com/health-information/diseases-and-conditions/p/pseudomembranous-colitis/

  Bezlotoxumab (Zinplava). The U.S. Food and Drug Administration (FDA) has approved the use of human monoclonal antibody bezlotoxumab to reduce the risk of recurrence of C. difficile infection. Used in combination with antibiotics, bezlotoxumab has been shown to significantly reduce the recurrence of infection. However, cost may be a limiting factor.

• #1 Pseudomembranous Colitis Surgery Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/193031-treatment

  The updated IDSA-SHEA guidelines published in 2021 favored fidaxomicin over vancomycin for initial and recurrent episodes of C difficile infection but noted that the latter agent remains an acceptable alternative. […] Metronidazole is an inexpensive, effective treatment for pseudomembranous colitis. […] Fidaxomicin is a macrolide antibiotic that is bactericidal against C difficile in vitro. […] Studies suggested that the monoclonal antibody bezlotoxumab may be effective for the prevention of recurrent C difficile infection. […] Cholestyramine contains anion exchange binding resins, which exert their beneficial effect in pseudomembranous colitis by binding C difficile toxins and eliminating these toxins from the colonic lumen. […] In patients with multiple relapses, attempts have been made to recolonize the colon by introducing organisms to suppress C difficile.

• #1 Pseudomembranous colitis: causes and cures – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10095149/

  Oral therapy with metronidazole 250 mg 4 times a day for 10 days is the recommended first-line therapy. […] Vancomycin is also effective, but its use must be limited to decrease the development of vancomycin-resistant organisms such as enterococci. Vancomycin (125-500 mg 4 times a day for 10 days) should be limited to those who cannot tolerate or have not responded to metronidazole, or when metronidazole use is contraindicated, as in the first trimester of pregnancy. […] Therapy with antibiotics in a pulsed or tapered regimen is often effective as are efforts to normalize the fecal flora. The yeast Saccharomyces boulardii has been proven in controlled trials to reduce recurrences when given as an adjunct to antibiotic therapy.

• #1 Pseudomembranous Colitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pseudomembranous-colitis

  Faecal microbiota transplant (FMT) is recommended by NICE as an option to treat recurrent Clostridioides difficile infection in adults who have had two or more previous confirmed episodes. […] Surgery may be life-saving for patients with acute severe colitis. […] Referral for a surgical opinion is required if the patient fails to respond to treatment or has signs of an acute abdomen, radiological signs of acute disease, a rising white blood cell count, a rising creatinine concentration, or a rising lactate concentration. […] There is insufficient evidence of any benefit with probiotic therapy as an adjunct to antibiotic therapy for C. difficile colitis. There is no evidence to support the use of probiotics alone in the treatment of C. difficile colitis.

• #1 Pseudomembranous Colitis Surgery Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/193031-treatment

  Fecal microbiota transplantation (FMT; given as an enema or through a nasogastric tube) from selected healthy donors, though it carries the risk of disease transmission, holds considerable promise as a therapy for recurrent or refractory cases. […] Corticosteroid therapy was reported to be safe and effective in the treatment of severe cases but is not widely recommended. […] Two thirds of patients with toxic megacolon require surgical intervention. […] Early subtotal colectomy is advocated by some surgeons in fulminant toxic cases that do not respond after a week of intensive medical therapy because the risk of perforation increases after 7 days of ineffective medical therapy.

• #1 Role of care surgery in the treatment of pseudomembranous colitis | Cirugía y Cirujanos (English Edition)

  https://www.elsevier.es/en-revista-cirugia-cirujanos-english-edition–237-articulo-role-care-surgery-in-treatment-S2444050717300475

  Pseudomembranous colitis, caused by Clostridium difficile, has seen an increased incidence in recent years, driven mainly by the indiscriminate use of antibiotics. […] Although initial treatment is medical, the role of emergency surgery has gained ground due to high mortality and the emergence of increasingly virulent strains. […] It is important to keep in mind the surgical option in treatment of pseudomembranous colitis, especially when it presents as fulminant colitis, there are associated complications or failure to respond to medical treatment. […] If this proves ineffective, surgery should be considered. […] Surgery is indicated in the case of any of the following factors: perforation or necrosis of the colon wall, the need for vasoactive drugs, signs of sepsis, changes in mental state, leukocytosis above 50,000, lactic acid greater than 5mmol/l, or if there has been no clinical improvement after 5 days of treatment.

• #1 Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication

  https://www.wjgnet.com/1007-9327/full/v19/i42/7476.htm

  Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication. […] The one-week triple therapy including proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate H. pylori infection in countries with low clarithromycin resistance. […] However, rare but severe adverse effects such as pseudomembranous colitis have been reported, Clostridium difficile infection being the main causative factor in all cases. […] Rapid resolution of symptoms and negative C. difficile toxins were obtained in both patients with oral vancomycin. […] After a 10-d treatment with oral vancomycin (125 mg every 6 h) both patients had complete resolution of symptoms and negative stool test for Clostridium difficile toxins.

• #1 Journal of Biomedical and Translational Research

  https://www.jbtr.or.kr/archive/view_article?pid=jbtr-15-1-44

  Pseudomembranous colitis (PMC) is known to be associated with the long-term administration of antibiotics, which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. However, antituberculosis agents are rarely reported as a cause of this disease. […] This report presents a case of PMC associated with antituberculosis therapy in a patient with tuberculous meningitis. […] Considering adverse drug reactions, antituberculosis agents were stopped. One week later, her symptoms were relieved. […] Thus, antituberculosis agents were reintroduced one at a time after liver function returned to normal. […] Sigmoidscopy revealed multiple yellowish plaques with edematous mucosa, which were compatible with PMC. She was treated with oral vancomycin considering drug interactions. Symptoms were relieved and did not recur when all antituberculosis agents except pyrazinamide were started again.

• #1 Pseudomembranous colitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/symptoms-causes/syc-20351434

  Treatment of pseudomembranous colitis is usually successful. […] Even with prompt diagnosis and treatment, pseudomembranous colitis can be life-threatening. […] In addition, pseudomembranous colitis may sometimes return, days or even weeks after apparently successful treatment.

• #1 Clostridium difficile–Associated Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0301/p921.html

  First-line therapy consists of metronidazole, 500 mg orally three or four times daily for 10 to 14 days. Metronidazole is an inexpensive drug with a greater than 90 percent positive response rate. […] Vancomycin also is an effective treatment, with a response rate of greater than 90 percent. If a patient is pregnant or does not respond to or tolerate metronidazole, vancomycin should be initiated in a dosage of 125 to 500 mg orally four times daily for 10 to 14 days. […] Response to therapy can be assessed by the resolution of fever, usually within the first two days. Diarrhea should resolve within two to four days. Treatment is continued for 10 to 14 days. Therapeutic failure is not determined until treatment has been given for at least five days. […] Twenty to 25 percent of patients with C. difficile infection will have recurrent infection. Recurrence seldom is caused by treatment-resistant strains; usually, it is due to the germination of persistent C. difficile spores in the colon after treatment or to reinfection because of reingestion of the pathogen. Management of recurrent C. difficile infections remains controversial, although most relapses respond to another course of antibiotics given in standard dosages for 10 to 14 days.

• #1 Beginner’s Guide To Beating Pseudomembranous Colitis (C. diff Colitis) | Diet vs Disease

  https://www.dietvsdisease.org/diet-for-pseudomembranous-colitis-c-diff/

  When pseudomembranous colitis is diagnosed, generally the first course of action is to stop taking the antibiotics that are suspected of causing the infection. […] Ironically, pseudomembranous colitis is also treated with antibiotics. Typically, metronidazole is used for mild to moderate symptoms, and vancomycin is used for severe cases. […] Most patients see improvements when treated with appropriate antibiotics. However, up to 35% will develop recurring diarrhea. […] Discontinuing the antibiotic that is suspected of leading to the infection is usually the first line of treatment. Metronidazole or vancomycin may then be prescribed. While these antibiotics help most people, some will develop recurring pseudomembranous colitis. […] Choose low fiber, low fat foods and drinks that are easy on the digestive system and don’t make diarrhea worse.

• #1 Pseudomembranous colitis: Symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/pseudomembranous-colitis

  In more severe cases, antibiotic therapy should be commenced soon, and typically within seven to 10 days, their condition should improve. In about 20% of cases, people may relapse after treatment has finished. […] People with pseudomembranous colitis should follow their doctors advice during the recovery process. They should not take any over-the-counter medication, such as antidiarrheal drugs, without checking first. These medications could affect healing or increase the risk of complications. […] Doctors may also recommend replacing lost electrolytes by drinking sports drinks or oral rehydration solutions. Eating a balanced diet and incorporating certain foods during this recovery period can also help prevent further nutrient loss.

• #1 Beginner’s Guide To Beating Pseudomembranous Colitis (C. diff Colitis) | Diet vs Disease

  https://www.dietvsdisease.org/diet-for-pseudomembranous-colitis-c-diff/

  It’s very important to stay well-hydrated. […] In cases of severe C. diff colitis, IV fluids and electrolyte replacement may be necessary. […] Avoid the following foods, which may make diarrhea and dehydration worse during an acute flare up: Fried and greasy foods, Foods with creamy sauces, Cakes and cookies, Fruits and vegetables that can cause gas and bloating. […] Not much research has looked at whether particular foods or diets can prevent pseudomembranous colitis. […] However, there’s 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 didn’t. […] Probiotic supplements are still speculative, although products with Saccharomyces boulardii or Lactobacillus GG are worth a try. […] Following these recommendations and being consistent with your diet changes and improvements can go a long way to prevent the inflammation from recurring.

• #2 Pseudomembranous Colitis – The Gastrointestinalatlas – gastrointestinalatlas.com

  https://www.gastrointestinalatlas.com/english/pseudomembranous_colitis.html

  Pseudomembranous colitis is a life-threatening complication of broad spectrum antibiotic therapy caused by Clostridium difficile. Untreated, the disease can lead to severe and in many cases fatal complications such as peritonitis due to colonic wall perforation, shock as a consequence of volume depletion, toxic megacolon and massive lower gastrointestinal haemorrhage. Fatal complications mostly occur in elderly people with a high degree of comorbidity. The risk of developing Clostridium difficile-induced colitis increases with age. […] Clostridium difficile-associated pseudomembranous colitis is an increasingly common nosocomial infection that usually responds to oral antibiotics. Two antibacterials have been shown to be effective in the treatment of pseudomembranous colitis: oral or parenteral metronidazole (250mg 4 times daily for 7 to 10 days) and oral vancomycin (from 125mg 3 times daily to 500mg 4 times daily in severe cases). Vancomycin is well tolerated compared with metronidazole but its cost is higher.

• #2 Pseudomembranous Colitis – The Gastrointestinalatlas – gastrointestinalatlas.com

  https://www.gastrointestinalatlas.com/english/pseudomembranous_colitis.html

  As soon as pseudomembranous colitis is suspected, the implicated antibacterial should be withdrawn, symptomatic treatment of diarrhea started and specific antibacterial therapy initiated. The diagnosis can be confirmed by the isolation of C. difficile or its toxins in stool. […] Therapy for PMC includes discontinuation of implicated antimicrobial agents, administration of antimicrobial agents directed against C. difficile, and supportive measures. Diarrhea will resolve without specific antimicrobial therapy in 15% to 25% of patients. Supportive measures include intravenous (IV) fluids to correct dehydration and electrolyte imbalance. Nutritional support may be required to correct hypoalbuminemia. Antiperistaltic agents should be avoided because they may delay clearance of toxins from the colon, leading to increased colonic injury, ileus, and toxic dilation.

• #2 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  In patients with severe, complicated, or fulminant CDI (hypotension, shock, ileus or megacolon), oral (or via nasogastric tube) vancomycin 500 mg every 6 hours along with intravenous (IV) metronidazole is recommended. Rectal vancomycin may also be added in patients with ileus. […] Treatment recommendations for CDI have evolved over the past few years. One reason for change is the frequent relapse rate of CDI (20-27%). In 2021, the ISDA recommended using fidaxomicin first line for treatment of an initial CDI episode as well as subsequent recurrence. Relative to vancomycin, fidaxomicin is not only a more targeted intestinal antibiotic but also associated with fewer CDI recurrences. Vancomycin is still considered to be an acceptable alternative. However, metronidazole is no longer recommended unless fidaxomicin and vancomycin are not available.

• #2 Pseudomembranous Colitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pseudomembranous-colitis

  Management of pseudomembranous colitis includes correcting fluid losses or electrolyte imbalance with oral or intravenous (IV) electrolyte solutions. […] Avoid antiperistaltic agents such as loperamide or opiates (codeine) because of the risk of retention of toxins in the lumen. […] Ceasing the causative antibiotic (if possible) allows resolution in ~3 days in 22%. Consider changing to an antibiotic less likely to cause PMC – for example, aminoglycosides, macrolides, vancomycin or tetracyclines. […] The National Institute for Health and Care Excellence (NICE) recommends the following antibiotics for adults aged 18 years and over: First-line antibiotic for a first episode of mild, moderate or severe C. difficile infection: Vancomycin: 125 mg orally four times a day for 10 days. […] Second-line antibiotic for a first episode of mild, moderate or severe C. difficile infection if vancomycin is ineffective: Fidaxomicin: 200 mg orally twice a day for 10 days.

• #2 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  Initial treatment: Treatment with fidaxomicin 200 mg by mouth twice a day for 10 days. If fidaxomicin is not available, then use oral vancomycin 125 mg by mouth four times a day for 10 days as an alternative. In nonsevere CDI (white blood cell [WBC] count 15,000 cells/uL and creatinine level 1.5 mg/dL), if fidaxomicin and vancomycin are not available, then use metronidazole 500 mg every 8 hours for 10-14 days. […] The FDA approved fidaxomicin for children aged 6 months or older in January 2020 for treatment of C difficile-associated diarrhea (CDAD). Approval was based on the phase 3 SUNSHINE clinical trial that included 148 randomized patients younger than 18 years with confirmed CDI, of whom 142 received either fidaxomicin or vancomycin in a 2:1 ratio. […] First recurrence: Fidaxomicin 200 mg by mouth twice a day for 10 days or a pulsed regimen. Alternative treatment: Vancomycin tapered or pulsed regimen may be considered with recurrent infection.

• #2 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  Severe infection, which is defined as a white blood cell count of 15.0 109/L or higher or a serum creatinine level greater than or equal to 1.5 times the premorbid level, should be treated with oral vancomycin 125 mg four times per day for 10 to 14 days. […] Severe C difficile infection complicated by hypotension, shock, ileus, or megacolon should be treated with a combination of high-dose oral vancomycin (and possibly rectal vancomycin as well) at 500 mg four times per day plus intravenous metronidazole.

• #2 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  Second recurrence or subsequent recurrences: Treatment recommendations are the same as that for the first recurrence, but consideration for FMT is also recommended after treatment of the second recurrence. […] Fulminant (hypotension or shock, ileus, or megacolon) CDI: Vancomycin 500 mg every 6 hours by mouth or nasogastric tube, combined with IV metronidazole 500 mg every 8 hours. In patients with ileus, consider adding rectal vancomycin 500 mg every 6 hours in 100 mL normal saline as a retention enema. […] In patients with suspected severe (WBC count 15,000 cells/uL and creatinine level 1.5mg/dL) or fulminant CDI, initiate early empirical therapy while the stool tests are pending. […] In a multicenter retrospective (2013-2014) study of CDI in 72 Spanish patients, fidaxomicin treatment was effective and well tolerated in patients with severe CDI as well as those at high risk of recurrent disease. The clinical cure rate was 90.3%, with a 16.7% recurrence and a 72.2% sustained cure.

• #2 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  The 2017 IDSA guidelines recommend oral vancomycin or fidaxomicin (Dificid) for treatment of nonsevere initial C. difficile infection. Multiple randomized, placebo-controlled trials have shown that oral vancomycin is superior to metronidazole, which is no longer recommended as a first-line treatment for initial episodes of C. difficile infection. […] Treatment options for the first recurrence include vancomycin if metronidazole was used for the initial episode, or if a standard vancomycin regimen was used for the initial episode, either fidaxomicin or a prolonged vancomycin taper followed by pulsed vancomycin. […] There are several treatment options for patients who have had multiple recurrent episodes of C. difficile infection and have received appropriate antibiotic therapy for at least three episodes. Vancomycin can be given, either in a tapered and pulsed regimen or four times per day for 10 days followed by rifaximin (Xifaxan) three times per day for 20 days. Alternatively, fidaxomicin can be used twice per day for 10 days. Fecal microbiota transplantation is also a reasonable option. […] Patients with severe C. difficile infection or fulminant colitis should receive immediate antibiotic therapy, supportive care, and close monitoring in a hospital setting. Some may require surgery for toxic megacolon, colonic perforation, or necrotizing colitis.

• #2 Pseudomembranous Colitis Surgery Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/193031-treatment

  Oral treatment with antimicrobial agents effective against C difficile is the preferred treatment. No reliable parenteral treatment for pseudomembranous colitis exists. […] In severe cases, in cases where supportive therapy fails, and in cases where the offending antibiotic cannot be discontinued, a short (7-10 d) course of specific antibiotic therapy should be administered along with the supportive therapy, and the offending antibiotic should be changed to another appropriate agent when possible. Recurrent diseases respond well to repeat treatment with vancomycin or fidaxomicin. […] Treatment with a combination of vancomycin and rifampin was reported to be successful in some cases. […] Vancomycin has been the most reliable treatment of the disease (90-100% response rate in adult men).

• #2 Pseudomembranous colitis

  https://www.mymlc.com/health-information/diseases-and-conditions/p/pseudomembranous-colitis/

  Treatment options may include: […] Repeat antibiotics. You may need a second or third round of antibiotics to resolve your condition and may need a longer duration of therapy. […] Surgery. Surgery may be an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall (peritonitis). Surgery has typically involved removing all or part of the colon (total or subtotal colectomy). […] A newer surgery that involves laparoscopically creating a loop of colon and cleaning it (loop ileostomy and colonic lavage) is less invasive and has had positive results. […] Fecal microbial transplantation (FMT). FMT is used to treat recurrent pseudomembranous colitis. You’ll receive healthy, cleaned stool in a capsule, nasogastrically or inserted into your colon.

• #2 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  In a retrospective study of 83 immunocompromised patients who underwent FMT for recurrent (12%), refractory (54%), or severe (34%) CDI, the cure rate after a single transplant was 79% (52 of the 66 patients with 12 weeks of follow-up). […] In November 2022, the FDA approved microbiota via rectal administration (Rebyota) for prevention of recurrence of CDI in adults following antibiotic treatment for CD recurrence. […] A second orally administered microbiota product (Vowst) received FDA approval in April 2023. Results from the ECOSPOR III phase 3 double-blind, randomized, placebo-controlled trial showed a decreased recurrence of CDI in patients treated orally with microbiota compared with placebo (12% vs 40%, respectively; P 0.001).

• #2

  http://www.tropicalgastro.com/printerfriendly.aspx?id=1933

  Starting from day 7, she received FMT once in every 5 days for a total of 4 times. […] The sigmoidoscopic picture started improving after first FMT itself and there was complete healing of the lesions after the fourth FMT. […] Treatment of CDI depends on the grade of severity. […] The recommended treatment for mild disease is oral metronidazole, for moderate disease is oral vancomycin, for severe disease is oral vancomycin and IV metronidazole and for complicated disease is the above treatment with or without surgery. […] However, newer guidelines advocate FMT for severe refractory CDI even during the first episode. […] In our case, as the disease was severe and not responding to the standard line of management, we decided to use FMT. […] The principle of FMT is bacterial interference by restoration of missing components of the bacterial flora and replacing pathogenic organisms.

• #2 Ulcerative Colitis and C. diff: Symptoms, Treatment, FAQs

  https://www.healthline.com/health/ulcerative-colitis/ulcerative-colitis-and-c-diff

  C. diff is treatable with antibiotics like vancomycin or fidaxomicin. […] A doctor may recommend a fecal transplant if you have recurrent C. diff infections. A fecal transplant involves inserting stool from a donor into your gastrointestinal tract. It can help restore a balance to your gut microbiome. […] The Food and Drug Administration (FDA) has also approved two new forms of fecal transplants that may be less intrusive: Rebyota, which is an injection administered in a doctors office, and Vowst, which are capsules taken by mouth. […] Research shows that fecal transplants are usually safe and effective for treating C. diff infections, but experts need more clinical trials to understand how well they work in people with UC. […] While you receive treatment for C. diff infection, your doctor might also change your other UC medications. They may decide to increase or decrease the dosage of immunosuppressive therapy. Your doctor will monitor you for complications or worsening symptoms.

• #2 Clostridioides (formerly Clostridium) difficile–Induced Diarrhea – Infectious Diseases – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/infectious-diseases/anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-diarrhea

  Vancomycin in a tapered and pulsed regimen or as a standard course are alternatives for a first recurrence. […] For patients with multiple recurrences, vancomycin in a tapered and pulsed regimen, vancomycin followed by rifaximin, and fecal microbiota transplantation are options in addition to fidaxomicin. […] Infusion of donor feces (fecal transplant, usually done via colonoscopy) increases the likelihood of resolution in patients who have frequent recurrences; presumably, the mechanism is restoration of normal fecal microbiota. […] A human monoclonal antibody, bezlotoxumab 10 mg/kg IV given once, binds to and neutralizes C. difficile toxin B; it can be used for prevention of recurrent C. difficile induced diarrhea along with standard-of-care treatment in patients who have had a recurrence within the last 6 months.

• #2 Pseudomembranous Colitis – Holland-Frei Cancer Medicine – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK12749/

  The treatment of antibiotic-associated pseudomembranous colitis requires discontinuation of the implicated antibiotic. Many patients improve spontaneously with only this measure; however, specific therapy shortens the duration of symptoms. The most widely used agent is oral vancomycin, which, like metronidazole, is poorly absorbed and reaches high concentrations in the stool. Both oral vancomycin and metronidazole are effective treatments of pseudomembranous colitis, and a comparison of these agents in a randomized trial demonstrated equal efficacy and relapse rates of 8% to 9%, respectively. Metronidazole is much more economical than vancomycin and is therefore recommended for initial therapy. The usual initial dosage is 250 mg qid, but 500 mg tid is also appropriate. Vancomycin is often reserved for patients who fail to respond to metronidazole therapy. A randomized trial found that vancomycin at 125 mg orally four times daily for an average of 10 days was as active as the 500 mg dose given four times daily. Relapse of symptoms and a repeat positive toxin assay is not uncommon after responding to and completing initial therapy. Most relapsing patients will respond to a second course of treatment, but some patients suffer multiple relapses. Some relapsing patients have been shown to acquire a different strain of C. difficile, and these patients will respond to a second course of the same antibiotic. Alternately, one can use vancomycin if metronidazole was used initially, and vice versa. Cholestyramine is an anion exchange resin that binds to the enterotoxin of C. difficile (aborts its cytotoxic activity in vitro), and that has been used with success in refractory cases. Cholestyramine also binds vancomycin; therefore, these agents should not be used in combination. In the rare patient with a severe complication such as toxic megacolon or perforation, surgical management may be required.

• #2 Pseudomembranous enterocolitis – wikidoc

  https://www.wikidoc.org/index.php/Pseudomembranous_enterocolitis

  Cholestyramine and other bile acid sequestrants should not be used as adjunctive therapy because, though they may bind the C. difficile toxin, they can also inhibit the effects of the primary antibiotic. […] Several probiotic therapies have been used as adjunct therapies for pseudomembranous colitis. Saccharomyces boulardii (similar to baker’s yeast) has been shown in one small study of 124 patients to reduce the recurrence rate of pseudomembranous colitis. A number of mechanisms have been proposed to explain this effect. Fecal bacteriotherapy, a medical treatment which involves restoration of colon homeostasis by reintroducing normal bacterial flora using faecal material obtained from a healthy donor, has been successfully used to treat acute pseudomembranous colitis. […] If antibiotics do not control the infection, the patient may require a colectomy (removal of the colon) for treatment of the colitis in life-threatening cases.

• #2

  https://journals.lww.com/ajg/fulltext/2011/10002/mesalamine_granules_for_the_treatment.967.aspx

  The incidence of Clostridium difficile infection (CDI) has been on the rise during the last 10 to 20 years, presumably in part because of increasing antibiotic use. A major complication of CDI is pseudomembranous colitis, which is characterized by the appearance of pseudomembranes lining the colonic mucosa. This case examines mesalamine granules (MG) for treatment of underlying pseudomembranous pancolitis in a patient who had antibiotic-triggered CDI. […] Treatment with MG for underlying pancolitis in a patient with antibiotic-triggered CDI resulted in complete symptom resolution with mucosal healing. Antibiotics such as vancomycin and rifaximin resolved the CDI, whereas mesalamine agents controlled the patient’s symptoms and improved the underlying inflammation caused by the CDI.

• #2 Australasian Society for Infectious Diseases guidelines for the diagnosis and treatment of Clostridium difficile infection | The Medical Journal of Australia

  https://www.mja.com.au/journal/2011/194/7/australasian-society-infectious-diseases-guidelines-diagnosis-and-treatment

  The preferred treatment for a first recurrence is readministration of metronidazole, with vancomycin reserved for severe cases. […] For second or subsequent recurrences, there is some concern about the cumulative toxicity of metronidazole, and an alternative antibiotic would be preferable. […] Faecal enemas (or preparations administered by nasogastric tube) to restore commensal flora (stool transplant) have been used successfully in a number of refractory cases of recurrence. […] The routine use of probiotics cannot be recommended for treating CDI, particularly in critically ill patients.

• #2 Role of care surgery in the treatment of pseudomembranous colitis | Cirugía y Cirujanos (English Edition)

  https://www.elsevier.es/en-revista-cirugia-cirujanos-english-edition–237-articulo-role-care-surgery-in-treatment-S2444050717300475

  Pseudomembranous colitis, caused by Clostridium difficile, has seen an increased incidence in recent years, driven mainly by the indiscriminate use of antibiotics. […] Although initial treatment is medical, the role of emergency surgery has gained ground due to high mortality and the emergence of increasingly virulent strains. […] It is important to keep in mind the surgical option in treatment of pseudomembranous colitis, especially when it presents as fulminant colitis, there are associated complications or failure to respond to medical treatment. […] If this proves ineffective, surgery should be considered. […] Surgery is indicated in the case of any of the following factors: perforation or necrosis of the colon wall, the need for vasoactive drugs, signs of sepsis, changes in mental state, leukocytosis above 50,000, lactic acid greater than 5mmol/l, or if there has been no clinical improvement after 5 days of treatment.

• #2 Pseudomembranous colitis: Not always Clostridium difficile | MDedge

  https://medauth2.mdedge.com/content/pseudomembranous-colitis-not-always-clostridium-difficile

  Pseudomembranous colitis is most often due to Clostridium difficile infection, but it has a variety of other causes, including other infections, ischemia, medications, and inflammatory mucosal diseases. When pseudomembranes are found, one should consider these other causes if tests for C difficile are negative or if anti-C difficile therapy does not produce a response. […] These less common causes are important to consider to avoid needlessly escalating anti-C difficile antibiotic therapy and to provide appropriate treatment. […] If testing for C difficile is positive, treatment is generally based on the severity and the complications of the illness: Mild or moderate C difficile infection should be treated with oral metronidazole 500 mg three times per day for 10 to 14 days. Severe infection, which is defined as a white blood cell count of 15.0 10^9/L or higher or a serum creatinine level greater than or equal to 1.5 times the premorbid level, should be treated with oral vancomycin 125 mg four times per day for 10 to 14 days. Severe C difficile infection complicated by hypotension, shock, ileus, or megacolon should be treated with a combination of high-dose oral vancomycin (and possibly rectal vancomycin as well) at 500 mg four times per day plus intravenous metronidazole. […] Additional treatment recommendations for individualized situations, recurrent C difficile infection, and comorbid conditions are discussed elsewhere.

• #2 Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication

  https://www.wjgnet.com/1007-9327/full/v19/i42/7476.htm

  Clinicians should have a high index of suspicion of pseudomembranous colitis as a rare, but severe complication of H. pylori therapy. […] Severe adverse effects such as pseudomembranous colitis following eradication therapy have very rarely been reported which is quite surprising, taken into account the immense number of subjects treated worldwide. […] Both our cases met the criteria for a severe form of disease, and were treated with vancomycin according to current guidelines recommendations. […] Our cases, in addition to the ones published, demonstrate that pseudomembranous colitis can occur after a usually well-tolerated triple therapy for H. pylori eradication. […] However, C. difficile infection may occur with an eradication therapy for H. pylori consisting of two antibiotics and a PPI. […] In conclusion, pseudomembranous colitis should be suspected in any patient with watery diarrhea during or after triple therapy for H. pylori eradication.

• #2 Journal of Biomedical and Translational Research

  https://www.jbtr.or.kr/archive/view_article?pid=jbtr-15-1-44

  Therefore, when a patient complains of abdominal pain or diarrhea after initiation of antituberculosis therapy, the physician should consider the possibility of antituberculosis agent-associated PMC. […] Once PMC is diagnosed, it is usually treated with oral therapy with metronidazole 250 mg, 4 times per day for 10 days, is the recommended first-line therapy for PMC. […] In presenting case, because risks of drug interactions between antitubercular agents and metronidazole were expected, we treated with oral vancomycin. […] When a patient who has not received antimicrobial therapy complains of abdominal pain or diarrhea while taking antitubercular drugs, clinicians must keep in mind and should be evaluated for the possibility of antitubercular agent-associated PMC.

• #2 Pseudomembranous colitis: Symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/pseudomembranous-colitis

  In more severe cases, antibiotic therapy should be commenced soon, and typically within seven to 10 days, their condition should improve. In about 20% of cases, people may relapse after treatment has finished. […] People with pseudomembranous colitis should follow their doctors advice during the recovery process. They should not take any over-the-counter medication, such as antidiarrheal drugs, without checking first. These medications could affect healing or increase the risk of complications. […] Doctors may also recommend replacing lost electrolytes by drinking sports drinks or oral rehydration solutions. Eating a balanced diet and incorporating certain foods during this recovery period can also help prevent further nutrient loss.

• #2 Beginner’s Guide To Beating Pseudomembranous Colitis (C. diff Colitis) | Diet vs Disease

  https://www.dietvsdisease.org/diet-for-pseudomembranous-colitis-c-diff/

  When pseudomembranous colitis is diagnosed, generally the first course of action is to stop taking the antibiotics that are suspected of causing the infection. […] Ironically, pseudomembranous colitis is also treated with antibiotics. Typically, metronidazole is used for mild to moderate symptoms, and vancomycin is used for severe cases. […] Most patients see improvements when treated with appropriate antibiotics. However, up to 35% will develop recurring diarrhea. […] Discontinuing the antibiotic that is suspected of leading to the infection is usually the first line of treatment. Metronidazole or vancomycin may then be prescribed. While these antibiotics help most people, some will develop recurring pseudomembranous colitis. […] Choose low fiber, low fat foods and drinks that are easy on the digestive system and don’t make diarrhea worse.

• #2 Clostridioides difficile colitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/clostridioides-difficile-colitis?lang=us

  Treatment involves supportive therapy (fluid and electrolyte replacement) and eradication of C. difficile with antibiotics (usually vancomycin or metronidazole). […] A novel treatment option is that of fecal transplant, whereby 'healthy’ fecal matter is either administered via nasogastric tube or directly into the colon, after having been donated by a family member. […] Untreated pseudomembranous colitis carries a high mortality from the sequelae of toxic megacolon and perforation.

• #2 Beginner’s Guide To Beating Pseudomembranous Colitis (C. diff Colitis) | Diet vs Disease

  https://www.dietvsdisease.org/diet-for-pseudomembranous-colitis-c-diff/

  It’s very important to stay well-hydrated. […] In cases of severe C. diff colitis, IV fluids and electrolyte replacement may be necessary. […] Avoid the following foods, which may make diarrhea and dehydration worse during an acute flare up: Fried and greasy foods, Foods with creamy sauces, Cakes and cookies, Fruits and vegetables that can cause gas and bloating. […] Not much research has looked at whether particular foods or diets can prevent pseudomembranous colitis. […] However, there’s 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 didn’t. […] Probiotic supplements are still speculative, although products with Saccharomyces boulardii or Lactobacillus GG are worth a try. […] Following these recommendations and being consistent with your diet changes and improvements can go a long way to prevent the inflammation from recurring.

• #2 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Guidelines for the diagnosis and treatment of Clostridioides difficile infection have recently been updated. Treatment depends on whether the episode is an initial vs. recurrent infection and on the severity of the infection based on white blood cell count, serum creatinine level, and other clinical signs and symptoms. For an initial episode of nonsevere C. difficile infection, oral vancomycin or oral fidaxomicin is recommended. Metronidazole is no longer recommended as first-line therapy for adults. Fecal microbiota transplantation is a reasonable treatment option with high cure rates in patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes. […] Oral vancomycin and fidaxomicin (Dificid) are preferred over metronidazole for initial episodes of C. difficile infection. Fecal microbiota transplantation is recommended for patients with multiple recurrences of C. difficile infection in whom appropriate antibiotic therapy has been ineffective.

• #2 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  In fulminant cases, combined therapy with IV metronidazole and vancomycin (PO or PR) is the treatment of choice. IV vancomycin is ineffective and should not be used for C difficile. […] FMT is a novel therapy that involves the transfer of stool from a healthy donor to a patient with CDI to reconstitute the normal colonic microbial flora. It is given after treating CDI with antibiotics. Studies have evaluated prevention of recurrence of CDI after FMT. […] Several studies have shown that FMT by colonoscopy or enema was an effective approach for patients with recurrent CDI, with clinical success rates of up to 95%. […] In the first randomized, controlled trial of FMT, investigators in The Netherlands found fecal transfer to be 3 times more effective than antibiotics in curing recurrent CDI, leading to the study’s early termination.

• #3 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  Initial treatment: Treatment with fidaxomicin 200 mg by mouth twice a day for 10 days. If fidaxomicin is not available, then use oral vancomycin 125 mg by mouth four times a day for 10 days as an alternative. In nonsevere CDI (white blood cell [WBC] count 15,000 cells/uL and creatinine level 1.5 mg/dL), if fidaxomicin and vancomycin are not available, then use metronidazole 500 mg every 8 hours for 10-14 days. […] The FDA approved fidaxomicin for children aged 6 months or older in January 2020 for treatment of C difficile-associated diarrhea (CDAD). Approval was based on the phase 3 SUNSHINE clinical trial that included 148 randomized patients younger than 18 years with confirmed CDI, of whom 142 received either fidaxomicin or vancomycin in a 2:1 ratio. […] First recurrence: Fidaxomicin 200 mg by mouth twice a day for 10 days or a pulsed regimen. Alternative treatment: Vancomycin tapered or pulsed regimen may be considered with recurrent infection.

• #3

  http://www.tropicalgastro.com/printerfriendly.aspx?id=1933

  In our case, the patient required four such cycles and sigmoidoscopy after the fourth FMT showed complete resolution of the lesions with significant clinical improvement. […] FMT is a good modality for the first attack of severe CDI not responding to standard lines of management. This case illustrates the importance of FMT in severe refractory C. difficile colitis.

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