IDIS Index Record 674116
CLOSTRIDIUM DIFFICILE INFECTION IN OLDER ADULTS: A REVIEW AND UPDATE ON ITS MANAGEMENT
KEE V R
AM J GERIATR PHARMACOTHER, vol 10, iss 1, p 14-24, yr 2012
METRONIDAZOLE 8320004; VANCOMYCIN 8122813; FIDAXOMICIN 8122950; YEAST CELL DERIVATIVE-LIVE 84360013; RIFAMPIN 8123099; NITAZOXANIDE 8040012; RIFAXIMIN 8123006; TIGECYCLINE 8122407; LACTOBACILLUS SPECIES 56080025; IMMUNE GLOBULIN 80040008; C DIFFICILE A MONOCLONAL AB 82000534; C DIFFICILE B MONOCLONAL AB 82000535
COLITIS, PSEUDOMEMBRANOUS 008.45
REVIEW ADULT 6; REVIEW GERIATRIC 23; DRUG COMBINATION 16; PRODUCT DESCRIPTION 45; ADM ORAL 64; ADM PARENT INTRAVENOUS 66; PKIN EXCRETION RENAL 25; PKIN ABSORPTION 37; PKIN DISTRIBUTION 38; PKIN BIOTRANSFORMATION 39; PKIN EXCRETION 40; PKIN EXCRETION METABOLIC 51; PKIN BLOOD CONCENTRATION 63; PKIN PHARMACOKINETICS 74; PKIN AUC 95; DOSAGE 43
Background: Clostridium difficile is a main cause of health care-associated infections. The incidence and severity have been increasing. Elderly persons are at an increased risk of morbidity and mortality from C. difficile infection (CDI). Relatively few advances have been made in the treatment of CDI since it was first identified as a cause of antibiotic-associated diarrhea more than 30 years ago.
Objective: This article reviews CDI and provides an update on its treatment, including recently published clinical practice guidelines and the recently approved drug, fidaxomicin.
Methods: English-language literature was identified through a search of PubMed (1966-October 2011), Iowa Drug Information Service (1966-October 2011), and International Pharmaceutical Abstracts (1970-October 2011). Key search terms included Clostridium difficile, Clostridium infections, pseudomembranous colitis, antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, elderly, geriatric, epidemiology, microbiology, diagnosis, risk factors, treatment, drug therapy, vancomycin, metronidazole, and fidaxomicin.
Results: Metronidazole and vancomycin remain the mainstays of CDI treatment. Current guidelines recommend oral metronidazole for initial mild to moderate episodes or first recurrence. Oral vancomycin is recommended for initial severe episodes, or first or second recurrence. Fidaxomicin was approved in 2011 for treatment of CDI, but its place in therapy has yet to be determined. Other antibiotics have been used with variable success. Saccharomyces boulardii is the only probiotic that has shown efficacy in CDI. Fecal transplants have been used successfully in some patients, but randomized studies are needed. Immune therapy with a vaccine and monoclonal antibodies is being studied in clinical trials.
Conclusions: Treatment of CDI is challenging due to the limited number of drugs that have proven to be effective, concerns about antibiotic resistance, and recurring disease. The recent approval of fidaxomicin provides a new alternative. Immune therapy will likely play a greater role in the future.