GASTROENTEROLOGY ARTICLE OF THE WEEK
September 24, 2009
Leffler DA, Lamont JT. Treatment of clostridium difficile-associated disease. Gastroenterology 2009;136:1899-1912.
1. Parameters that indicate severe C. difficile colitis include
a. Age >60 years
b. WBC >15,000
c. More than 4 stools/day
d. Albumin <2.5 g/dL
e. Lack of fever
f. Elevated lactic acid
2. The NAP1/027 strain of C. difficile colitis is characterized by:
a. Invasion of the colonic mucosa leading to septicemia
b. Higher levels of toxin production
c. Higher clinical failure rate to metronidazole therapy
d. 3-fold higher mortality than the usual strain.
e. Quinolone resistance
f. Lower response to vancomycin
3.
Recurrence rate after the first episode of C. difficile colitis is
a. <5%
b. 5-10%
c. 15% - 30%
d. 50%-60%
e. >60%
True or False
4. Metronidazole is not recognized as a cause of C. difficile colitis
5. Oral vancomycin may not be effective in patients with ileus as the drug may not reach the colon.
6. C. difficile causes diarrhea by invading the colonic mucosa and disrupting electrolyte transport in the colon.
7. Vancomycin is the antibiotic of choice to treat C. difficile in pregnancy
8. Patients with mild C. difficile colitis can be managed by stopping the offending antibiotic and monitoring without metronidazole therapy
9. Patients with fulminant C. difficile colitis should be treated with IV metronidazole and oral or rectal vancomycin
10. IVIG infusion may be used for patients with fulminant C. difficile colitis not responding to antibiotics who are not good surgical candidates.
11. PPI therapy increases the risk of C. difficile by allowing spores to pass the stomach intact.
12. Antibiotic therapy for C. difficile may result in longer time to clearance of C. difficile spores
13. Vancomycin, like metronidazole, can be given IV to treat C. difficile colitis in patients unable to take po intake.
14. Rifaximin appears to have in-vitro and in-vivo efficacy against C. difficile but resistance emerges rather quickly
15. Recurrence rate after treating the first recurrence is <65%