Antibiotic therapy and new non-pharmacological therapies in infections by Clostridium difficile
Keywords:
Clostridium difficile, Clostridium difficile infection, pseudomembranous colitis.Abstract
Clostridium difficile infection is the leading cause of hospital acquired diarrhea. The patients can be asymptomatic carriers or present a mild diarrhea, a pseudomembranous colitis, toxic megacolon, sepsis and death. There is controversy in this infection’s including the best method of diagnosis and also regarding therapeutic regimen. In cases in which Clostridium infection is confirmed, the first and most effective measure is the withdrawal of any antibiotic treatment the patient is receiving, if possible. The antimicrobial treatment is based on three classic agents: metronidazole, vancomycin and teicoplanin, along with the recent addition of fidaxomicin and ridinilazol. Patients presenting serious symptoms, in addition to appropriate support and monitoring measures, may require surgical treatment. This review’s aim is to provide an update on the pathogenesis, and therapeutic strategies on the management of this pathogen.
References
[1] J. Freeman, M. P. Bauer, S. D. Baines, J. Corver, W. N. Fawley, B. Goorhuis, E. J. Kuijper, and M. H. Wilcox, “The changing epidemiology of Clostridium difficile infections,” Clin. Microbiol. Rev., vol. 23, no. 3, pp. 529–549, 2010.
[2] V. Loo, L. Poirier, M. Miller, M. Oughton, M. Libman, S. Michaud, A. M. Bourgault, T. Nguyen, C. Frenette, M. Kelly, A. Vibien, P. Brassard, S. Fenn, K. Dewar, T. Hudson, R. Horn, P. René, Y. Monczak, and A. Dascal, “A Predominantly Clonal Multi-Institutional Outbreak of,” N. Engl. J. Med., vol. 353, no. 23, pp. 2442–9, 2005.
[3] C. Quesada-Gómez, C. Rodríguez, M. Gamboa-Coronado, E. Rodríguez-Cavallini, T. Du, M. Mulvey, M. Villalobos-Zúñiga, and R. Boza-Cordero, “Emergence of Clostridium difficile NAP1 in Latin America,” J. Clin. Microbiol., vol. 48, no. 2, pp. 669–670, 2010.
[4] V.-Z. Manuel Antonio and B.-C. Ricardo, “Caracterización epidemiológica, clínica y microbiológica del brote de diarrea asociado a Clostridium difficile, ocurrido en el Hospital San Juan de Dios, 2008-2009,” Acta méd. costarric, vol. 54, no. 3, pp. 152–158, 2012.
[5] L. Meyer, R. Espinoza, and R. Quera, “Infección por Clostridium difficile: Epidemiología, Diagnóstico y Estrategias Terapéuticas,” Rev. Med. Clin. Condes, vol. 25, no. 3, pp. 473–484, 2014.
[6] F. Y. Khan and A.-N. Elzouki, “Clostridium difficile infection: a review of the literature.,” Asian Pac. J. Trop. Med., vol. 7S1, no. Suppl 1, pp. S6–S13, 2014.
[7] K. C. Carroll and J. G. Bartlett, “Biology of Clostridium difficile: implications for epidemiology and diagnosis.,” Annu. Rev. Microbiol., vol. 65, pp. 501–21, 2011.
[8] C. Frädrich, L.-A. Beer, and R. Gerhard, “Reactive Oxygen Species as Additional Determinants for Cytotoxicity of Clostridium difficile Toxins A and B,” Toxins (Basel)., vol. 8, no. 25, 2016.
[9] E. B. Chahine and A. J. Sucher, “An Update on Clostridium difficile Infection and its Management,” Drug Topics, vol. 154, no. 12, pp. 30–41, 2010.
[10] C. Vaishnavi, “Clostridium difficile infection: clinical spectrum and approach to management.,” Indian J. Gastroenterol., vol. 30, no. 6, pp. 245–54, 2011.
[11] B. Faris, a Blackmore, and N. Haboubi, “Review of medical and surgical management of Clostridium difficile infection.,” Tech. Coloproctol., vol. 14, no. 2, pp. 97–105, 2010.
[12] S. H. Cohen, D. N. Gerding, S. Johnson, C. P. Kelly, V. G. Loo, L. C. McDonald, J. Pepin, and M. H. Wilcox, “Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) •,” Infect. Control Hosp. Epidemiol., vol. 31, no. 5, pp. 431–455, 2010.
[13] D. K. C. Lamp, C. D. Freeman, N. E. Klutman, and M. K. Lacy, “Pharmacokinetics and Pharmacodynamics of the Nitroimidazole Antimicrobials,” Clin. Pharmacokinet., vol. 36, no. 5, pp. 353–373, 1999.
[14] S. Löfmark, C. Edlund, and C. E. Nord, “Metronidazole Is Still the Drug of Choice for Treatment of Anaerobic Infections,” Clin. Infect. Dis., vol. 50, no. s1, pp. S16–S23, 2010.
[15] C. R. Musgrave, P. B. Bookstaver, S. S. Sutton, and A. D. Miller, “Use of alternative or adjuvant pharmacologic treatment strategies in the prevention and treatment of Clostridium difficile infection,” Int. J. Infect. Dis., vol. 15, no. 7, pp. e438–e448, 2011.
[16] L. C. Pineda and K. M. Watt, “New Antibiotic Dosing in Infants,” Clin. Perinatol., vol. 42, no. 1, pp. 167–176, 2014.
[17] M. M. Soriano and S. Johnson, “Treatment of Clostridium difficile Infections,” Infect. Dis. Clin. North Am., vol. 29, no. 1, pp. 93–108, 2015.
[18] M. J. Rybak, “The pharmacokinetic and pharmacodynamic properties of vancomycin.,” Clin. Infect. Dis., vol. 42 Suppl 1, no. Suppl 1, pp. S35–S39, 2006.
[19] C. Vaishnavi, “Fidaxomicin - the new drug for Clostridium difficile infection,” Indian J Med Res, vol. 141, no. April, pp. 398–407, 2015.
[20] G. G. Zhanel, A. J. Walkty, J. A. Karlowsky, G. G. Zhanel, A. J. Walkty, J. A. Karlowsky, and A. Fidaxomicin, “Fidaxomicin : A novel agent for the treatment of Clostridium difficile infection,” Can J Infect Dis Med Microbiol, vol. 26, no. 6, pp. 305–312, 2015.
[21] T. Crawford, E. Huesgen, and L. Danziger, “Fidaxomicin: a novel macrocyclic antibiotic approved for treatment of Clostridium difficile infection,” Am. J. Heal. Pharm., vol. 69, no. 6, pp. 933–943, 2012.
[22] O. A. Cornely, D. Nathwani, C. Ivanescu, O. Odufowora-Sita, P. Retsa, and I. A. O. Odeyemi, “Clinical efficacy of fidaxomicin compared with vancomycin and metronidazole in Clostridium difficile infections: a meta-analysis and indirect treatment comparison,” J. Antimicrob. Chemother., vol. 69, no. 11, pp. 2892–2900, 2014.
[23] S. Curry, “Clostridium difficile.,” Clin. Lab. Med., vol. 30, no. 1, pp. 329–42, 2010. [24] K. Z. Vardakas, K. a. Polyzos, K. Patouni, P. I. Rafailidis, G. Samonis, and M. E. Falagas, “Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: A systematic review of the evidence,” Int. J. Antimicrob. Agents, vol. 40, no. 1, pp. 1–8, 2012.
[25] M. Drekonja, M. Butler, R. MacDonald, D. Bliss, G. A. Filice, T. S. Rector, and T. J. Wilt, “Comparative Effectiveness of Clostridium difficile Treatments,” Ann. Intern. Med., vol. 155, no. 12, pp. 839–847, 2011.
[26] R. Li, L. Lu, Y. Lin, M. Wang, and X. Liu, “Efficacy and Safety of Metronidazole Monotherapy versus Vancomycin Monotherapy or Combination Therapy in Patients with Clostridium difficile Infection: A Systematic Review and Meta-Analysis,” PLoS One, vol. 10, no. 10, 2015.
[27] X. Di, N. Bai, X. Zhang, B. Liu, W. Ni, J. Wang, K. Wang, B. Liang, Y. Liu, and R. Wang, “A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity.,” Brazilian J. Infect. Dis., vol. 19, no. 4, pp. 339–349, 2015.
[28] K. B. To and L. M. Napolitano, “Clostridium difficile Infection: Update on Diagnosis, Epidemiology, and Treatment Strategies,” Surg. Infect. (Larchmt)., vol. 15, no. 5, pp. 490–502, 2014.
[29] A. a. Venugopal and S. Johnson, “Current state of clostridium difficile treatment options,” Clin. Infect. Dis., vol. 55, no. SUPPL.2, pp. 71–76, 2012.
[30] H. Mathur, M. C. Rea, P. D. Cotter, R. Paul Ross, and C. Hill, “The potential for emerging therapeutic options for Clostridium difficile infection.,” Gut Microbes, vol. 5, no. 6, pp. 696–710, 2014.
[31] E. J. Goldberg, S. Bhalodia, S. Jacob, H. Patel, K. V. Trinh, B. Varghese, J. Yang, S. R. Young, and R. B. Raffa, “Clostridium difficile infection: A brief update on emerging therapies,” Am. J. Heal. Pharm., vol. 72, no. 12, pp. 1007–1012, 2015.
[32] E. Gough, H. Shaikh, and A. R. Manges, “Systematic Review of Intestinal Microbiota Transplantation (Fecal Bacteriotherapy) for Recurrent Clostridium difficile Infection,” Clin. Infect. Dis., vol. 53, no. 10, pp. 994–1002, 2011.
[33] Y.-T. Li, H.-F. Cai, Z.-H. Wang, J. Xu, and J.-Y. Fang, “Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection,” Aliment Pharmacol Ther, vol. 43, pp. 445–457, 2016.
[34] D. Drekonja, J. Reich, S. Gezahegn, N. Greer, A. Shaukat, R. MacDonald, I. Rutks, and T. J. Wilt, “Fecal Microbiota Transplantation for Clostridium difficile Infection,” Ann. Intern. Med., vol. 162, no. 9, p. 630, 2015.
[35] I. L. Scully, K. Swanson, L. Green, K. U. Jansen, and A. S. Anderson, “Anti-infective vaccination in the 21st century-new horizons for personal and public health,” Curr. Opin. Microbiol., vol. 27, pp. 96–102, 2015.
[36] A. Le Monnier, J. R. Zahar, and F. Barbut, “Update on Clostridium difficile infections,” Med. Mal. Infect., vol. 44, no. 8, pp. 354–365, 2014.
[37] R.vichers, G.Tillotson, E.Goldstein, D. Citron, K. Garey, M. Wilcox, “Ridinilazole: a novel therapy for Clostridium difficile infection”, International Journal of Antimicrobial Agents, no 48, pp.137-143, 2016.
[2] V. Loo, L. Poirier, M. Miller, M. Oughton, M. Libman, S. Michaud, A. M. Bourgault, T. Nguyen, C. Frenette, M. Kelly, A. Vibien, P. Brassard, S. Fenn, K. Dewar, T. Hudson, R. Horn, P. René, Y. Monczak, and A. Dascal, “A Predominantly Clonal Multi-Institutional Outbreak of,” N. Engl. J. Med., vol. 353, no. 23, pp. 2442–9, 2005.
[3] C. Quesada-Gómez, C. Rodríguez, M. Gamboa-Coronado, E. Rodríguez-Cavallini, T. Du, M. Mulvey, M. Villalobos-Zúñiga, and R. Boza-Cordero, “Emergence of Clostridium difficile NAP1 in Latin America,” J. Clin. Microbiol., vol. 48, no. 2, pp. 669–670, 2010.
[4] V.-Z. Manuel Antonio and B.-C. Ricardo, “Caracterización epidemiológica, clínica y microbiológica del brote de diarrea asociado a Clostridium difficile, ocurrido en el Hospital San Juan de Dios, 2008-2009,” Acta méd. costarric, vol. 54, no. 3, pp. 152–158, 2012.
[5] L. Meyer, R. Espinoza, and R. Quera, “Infección por Clostridium difficile: Epidemiología, Diagnóstico y Estrategias Terapéuticas,” Rev. Med. Clin. Condes, vol. 25, no. 3, pp. 473–484, 2014.
[6] F. Y. Khan and A.-N. Elzouki, “Clostridium difficile infection: a review of the literature.,” Asian Pac. J. Trop. Med., vol. 7S1, no. Suppl 1, pp. S6–S13, 2014.
[7] K. C. Carroll and J. G. Bartlett, “Biology of Clostridium difficile: implications for epidemiology and diagnosis.,” Annu. Rev. Microbiol., vol. 65, pp. 501–21, 2011.
[8] C. Frädrich, L.-A. Beer, and R. Gerhard, “Reactive Oxygen Species as Additional Determinants for Cytotoxicity of Clostridium difficile Toxins A and B,” Toxins (Basel)., vol. 8, no. 25, 2016.
[9] E. B. Chahine and A. J. Sucher, “An Update on Clostridium difficile Infection and its Management,” Drug Topics, vol. 154, no. 12, pp. 30–41, 2010.
[10] C. Vaishnavi, “Clostridium difficile infection: clinical spectrum and approach to management.,” Indian J. Gastroenterol., vol. 30, no. 6, pp. 245–54, 2011.
[11] B. Faris, a Blackmore, and N. Haboubi, “Review of medical and surgical management of Clostridium difficile infection.,” Tech. Coloproctol., vol. 14, no. 2, pp. 97–105, 2010.
[12] S. H. Cohen, D. N. Gerding, S. Johnson, C. P. Kelly, V. G. Loo, L. C. McDonald, J. Pepin, and M. H. Wilcox, “Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) •,” Infect. Control Hosp. Epidemiol., vol. 31, no. 5, pp. 431–455, 2010.
[13] D. K. C. Lamp, C. D. Freeman, N. E. Klutman, and M. K. Lacy, “Pharmacokinetics and Pharmacodynamics of the Nitroimidazole Antimicrobials,” Clin. Pharmacokinet., vol. 36, no. 5, pp. 353–373, 1999.
[14] S. Löfmark, C. Edlund, and C. E. Nord, “Metronidazole Is Still the Drug of Choice for Treatment of Anaerobic Infections,” Clin. Infect. Dis., vol. 50, no. s1, pp. S16–S23, 2010.
[15] C. R. Musgrave, P. B. Bookstaver, S. S. Sutton, and A. D. Miller, “Use of alternative or adjuvant pharmacologic treatment strategies in the prevention and treatment of Clostridium difficile infection,” Int. J. Infect. Dis., vol. 15, no. 7, pp. e438–e448, 2011.
[16] L. C. Pineda and K. M. Watt, “New Antibiotic Dosing in Infants,” Clin. Perinatol., vol. 42, no. 1, pp. 167–176, 2014.
[17] M. M. Soriano and S. Johnson, “Treatment of Clostridium difficile Infections,” Infect. Dis. Clin. North Am., vol. 29, no. 1, pp. 93–108, 2015.
[18] M. J. Rybak, “The pharmacokinetic and pharmacodynamic properties of vancomycin.,” Clin. Infect. Dis., vol. 42 Suppl 1, no. Suppl 1, pp. S35–S39, 2006.
[19] C. Vaishnavi, “Fidaxomicin - the new drug for Clostridium difficile infection,” Indian J Med Res, vol. 141, no. April, pp. 398–407, 2015.
[20] G. G. Zhanel, A. J. Walkty, J. A. Karlowsky, G. G. Zhanel, A. J. Walkty, J. A. Karlowsky, and A. Fidaxomicin, “Fidaxomicin : A novel agent for the treatment of Clostridium difficile infection,” Can J Infect Dis Med Microbiol, vol. 26, no. 6, pp. 305–312, 2015.
[21] T. Crawford, E. Huesgen, and L. Danziger, “Fidaxomicin: a novel macrocyclic antibiotic approved for treatment of Clostridium difficile infection,” Am. J. Heal. Pharm., vol. 69, no. 6, pp. 933–943, 2012.
[22] O. A. Cornely, D. Nathwani, C. Ivanescu, O. Odufowora-Sita, P. Retsa, and I. A. O. Odeyemi, “Clinical efficacy of fidaxomicin compared with vancomycin and metronidazole in Clostridium difficile infections: a meta-analysis and indirect treatment comparison,” J. Antimicrob. Chemother., vol. 69, no. 11, pp. 2892–2900, 2014.
[23] S. Curry, “Clostridium difficile.,” Clin. Lab. Med., vol. 30, no. 1, pp. 329–42, 2010. [24] K. Z. Vardakas, K. a. Polyzos, K. Patouni, P. I. Rafailidis, G. Samonis, and M. E. Falagas, “Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: A systematic review of the evidence,” Int. J. Antimicrob. Agents, vol. 40, no. 1, pp. 1–8, 2012.
[25] M. Drekonja, M. Butler, R. MacDonald, D. Bliss, G. A. Filice, T. S. Rector, and T. J. Wilt, “Comparative Effectiveness of Clostridium difficile Treatments,” Ann. Intern. Med., vol. 155, no. 12, pp. 839–847, 2011.
[26] R. Li, L. Lu, Y. Lin, M. Wang, and X. Liu, “Efficacy and Safety of Metronidazole Monotherapy versus Vancomycin Monotherapy or Combination Therapy in Patients with Clostridium difficile Infection: A Systematic Review and Meta-Analysis,” PLoS One, vol. 10, no. 10, 2015.
[27] X. Di, N. Bai, X. Zhang, B. Liu, W. Ni, J. Wang, K. Wang, B. Liang, Y. Liu, and R. Wang, “A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity.,” Brazilian J. Infect. Dis., vol. 19, no. 4, pp. 339–349, 2015.
[28] K. B. To and L. M. Napolitano, “Clostridium difficile Infection: Update on Diagnosis, Epidemiology, and Treatment Strategies,” Surg. Infect. (Larchmt)., vol. 15, no. 5, pp. 490–502, 2014.
[29] A. a. Venugopal and S. Johnson, “Current state of clostridium difficile treatment options,” Clin. Infect. Dis., vol. 55, no. SUPPL.2, pp. 71–76, 2012.
[30] H. Mathur, M. C. Rea, P. D. Cotter, R. Paul Ross, and C. Hill, “The potential for emerging therapeutic options for Clostridium difficile infection.,” Gut Microbes, vol. 5, no. 6, pp. 696–710, 2014.
[31] E. J. Goldberg, S. Bhalodia, S. Jacob, H. Patel, K. V. Trinh, B. Varghese, J. Yang, S. R. Young, and R. B. Raffa, “Clostridium difficile infection: A brief update on emerging therapies,” Am. J. Heal. Pharm., vol. 72, no. 12, pp. 1007–1012, 2015.
[32] E. Gough, H. Shaikh, and A. R. Manges, “Systematic Review of Intestinal Microbiota Transplantation (Fecal Bacteriotherapy) for Recurrent Clostridium difficile Infection,” Clin. Infect. Dis., vol. 53, no. 10, pp. 994–1002, 2011.
[33] Y.-T. Li, H.-F. Cai, Z.-H. Wang, J. Xu, and J.-Y. Fang, “Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection,” Aliment Pharmacol Ther, vol. 43, pp. 445–457, 2016.
[34] D. Drekonja, J. Reich, S. Gezahegn, N. Greer, A. Shaukat, R. MacDonald, I. Rutks, and T. J. Wilt, “Fecal Microbiota Transplantation for Clostridium difficile Infection,” Ann. Intern. Med., vol. 162, no. 9, p. 630, 2015.
[35] I. L. Scully, K. Swanson, L. Green, K. U. Jansen, and A. S. Anderson, “Anti-infective vaccination in the 21st century-new horizons for personal and public health,” Curr. Opin. Microbiol., vol. 27, pp. 96–102, 2015.
[36] A. Le Monnier, J. R. Zahar, and F. Barbut, “Update on Clostridium difficile infections,” Med. Mal. Infect., vol. 44, no. 8, pp. 354–365, 2014.
[37] R.vichers, G.Tillotson, E.Goldstein, D. Citron, K. Garey, M. Wilcox, “Ridinilazole: a novel therapy for Clostridium difficile infection”, International Journal of Antimicrobial Agents, no 48, pp.137-143, 2016.
Downloads
Published
2020-11-13
Issue
Section
Literature review
License
The intellectual property of accepted works belongs to their authors, however access to them is totally open and free, so they can be reproduced totally or partially with the only limitation of recognizing the authorship and the source of publication (Revista Medicina Legal de Costa Rica), as long as said exploitation does not have commercial character.
How to Cite
Antibiotic therapy and new non-pharmacological therapies in infections by Clostridium difficile. (2020). Medicina Legal De Costa Rica, 34(1). https://www.binasss.sa.cr/ojssalud/index.php/mlcr/article/view/52
