Question about treating c difficle

[Pinkleton]

So we had a patient who needed clindamycin but had a history of pseudo membranous colitis. I suggested we add oral vancomycin to prevent this, but the resident said they wanted to save the vanc as a last resort just in case she developed full blown c difficle infection. I don't understand the logic. I figured if the vanc works, it wouldn't matter if you gave it now or later. Can someone explain please?

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[Rendar5]

dunno, giving oral vanco to treat something that isn't there is like giving diflucan to every woman you give antibiotics to. all antibioticss cause C. Diff, not just clinda, so would you give oral vanco everytime she took any antibx? Honestly, if your'e concerned, go take a look to see if there are any studies done to see if empiric treatment works and in waht populations it was helpful, if it was at all.

 

[Pinkleton]

I believe she had it or it was clearing up, because we had her on metronidazole but wanted to switch to just 1 abx. I'm mostly curious about the logic of saving "our strongest weapon" as he put it

 

[Rendar5]

I believe she had it or it was clearing up, because we had her on metronidazole but wanted to switch to just 1 abx. I'm mostly curious about the logic of saving "our strongest weapon" as he put it

There are new antibiotics for it, so I think the logic is a bit specious. But personally speaking , you either have it or you don't have it. You don't treat it prophylactically as far as my own opinion is concerned.

 

[Top Gun]

You don't put someone on vanco or Flagyl just because you want to give that person an antibiotic, and that person had c diff in the past. Vanco and Flagyl are meant for treatment of c diff, not prophylaxis.

 

[evilbooyaa]

You don't put someone on vanco or Flagyl just because you want to give that person an antibiotic, and that person had c diff in the past. Vanco and Flagyl are meant for treatment of c diff, not prophylaxis.

This.

Even if they had C. Diff in the past, I don't know of any data that supports the use of prophylactic Metronidazole or Vanco in a patient receiving Abx. At least I've never heard of it.

 

[evilbooyaa]

I believe she had it or it was clearing up, because we had her on metronidazole but wanted to switch to just 1 abx. I'm mostly curious about the logic of saving "our strongest weapon" as he put it

Wanting to switch to 1 Abx? What does this mean? If the patient needed clinda, she would still need Metronidazole or Vanco to deal with a C. Diff infection (if present)

 

[AyCaramba]

Actually C. diff prophylaxis in pts with recent c. diff infection is a thing. It is usually done only if the pt is going to be receiving abx and has had c. diff in the past year or so. Typically the agent used is the agent that the previous C diff infection was treated with. I don't believe there is really data to support this practice, but I have in fact seen it described by ID specialists at my institution (not sure if internists outside of ID are familiar with this practice or not)

 

[evilbooyaa]

Quick pubmed search on prophylactic treatment of C. Diff, just based on the abstracts:

http://www.ncbi.nlm.nih.gov/pubmed/23683070

Fidaxomicin is a new drug that may be a potential for prophylaxis.

http://www.ncbi.nlm.nih.gov/pubmed/23569710

s/p Total Joint Arthroplasty, there is no mention of PPx Abx for C Diff

Not a lot I see about prophylactic Abx (at least to prevent C Diff. If anyone knows of any articles to the contrary I would love to see them.

 

[colbgw02]

Just give them a poop transplant.

 

[Pinkleton]

Quick pubmed search on prophylactic treatment of C. Diff, just based on the abstracts:

http://www.ncbi.nlm.nih.gov/pubmed/23683070

Fidaxomicin is a new drug that may be a potential for prophylaxis.

http://www.ncbi.nlm.nih.gov/pubmed/23569710

s/p Total Joint Arthroplasty, there is no mention of PPx Abx for C Diff

Not a lot I see about prophylactic Abx (at least to prevent C Diff. If anyone knows of any articles to the contrary I would love to see them.

Nice find!

 

[jakeislove]

Just give them a poop transplant.

Considering its effectiveness, I'm a little surprised repoopulating the bowel isn't done sooner.

 

[tco]

Go take a swig of vanc and you'll see why we don't use it for prophylaxis.

Also, there's that pesky issue of creating VRE.

 

[tco]

Wanting to switch to 1 Abx? What does this mean? If the patient needed clinda, she would still need Metronidazole or Vanco to deal with a C. Diff infection (if present)

I don't know the full details of the case, but I'm guessing the clinda was going to be used for aspiration pneumonia...

If that's true, they could have used tigecycline as the "one antibiotic" for C. diff and the pneumonia.

Still, prophylaxis for C. diff is not something that is generally accepted. Just wash your GD hands.

 

[blaqmamba]

poop transplants are closer to being implemented than you think. Poop Pills have been successfully developed in Europe

 

[colbgw02]

poop transplants are closer to being implemented than you think. Poop Pills have been successfully developed in Europe

not sure what you're getting at, but - while i wouldn't call it common yet - it isn't rare either. although the pill does sound a lot better than the current preferred route of administration.

 

[Instatewaiter]

poop transplants are closer to being implemented than you think. Poop Pills have been successfully developed in Europe

They already have been implemented.

I have always wondered who the first person was who was like, "You know what, I'm gonna take my **** and put it in your ass and treat some stuff."

 

[tco]

They already have been implemented.

I have always wondered who the first person was who was like, "You know what, I'm gonna take my **** and put it in your ass and treat some stuff."

Or worse yet, "I'm gonna take my **** and shove it down your NG tube, and treat some stuff."

 

[Instatewaiter]

Or worse yet, "I'm gonna take my **** and shove it down your NG tube, and treat some stuff."

Or worse still, "I'm gonna take my ****, stick it in a blender, then take an NG tube and shove both down your throat and treat some stuff. "

 

[evilbooyaa]

They already have been implemented.

I have always wondered who the first person was who was like, "You know what, I'm gonna take my **** and put it in your ass and treat some stuff."

Probably some guy who thought about the original relationship between Abx use and C. Diff in the first place. How long after people knew Abx use caused C. Diff did the first poop transplant happen?


Or a guy with a poop fetish who cured himself of C. Diff. One of the two.