PCC Conference 8-30-06. Marcia Lux, MD. By way of introduction…. New to the Division of GIM 7/1/06 Harvard Medical School, 2001 Columbia Presbyterian Internal Medicine Residency, 2001-2004 Hospitalist CPMC, 2004-2006 Case 1: July 2004 Case 2: May 2006. Case 1:.
Marcia Lux, MD
colonic flora (abx/chemo)
Colonization with toxigenic C. difficile
by fecal-oral transmission
Toxin A and B production
A/B: Cytoskeletal damage, loss of tight junctions.
A: Mucosal injury, inflammation, fluid secretion.
Colitis and Diarrhea
Adapted from Kelly CP & LaMont JT (1998). Clostridium difficile infection. Annual Review of Medicine 49, 375-390.
1. Discontinue offending agent or modify to less offensive agent (successful in 20% to 25%)
2. Replace fluids and electrolytes
3. Avoid antiperistaltic agents: may worsen diarrhea or precipitate toxic megacolon
4. If conservative measures not effective or practical, rx metronidazole 500 mg TID X 10d
[ can also use IV flagyl as good excretion into GI tract via bile and exudation from inflamed colon]
5. Re-treat first-time recurrences with the same regimen used to treat the initial episode
6. Avoid vancomycin if possible: equal efficacy but can lead to VREF. Cannot use IV vanco. Can use vancomycin enemas if NPO
7. Do not treat nosocomial diarrhea empirically without testing, <30% have C. dif infection
ER Dx: CAP; Rx: CTX/Azithro and admit