C Diff Drug Stewardship

In this video roundtable discussion, Jaspal Singh, MD, MHA, MHS, interviews Dr Lisa Davidson, MD, and Ryan Maves, MD, about the importance of antimicrobial stewardship, fighting antimicrobial resistance, diagnostic stewardship, minimizing toxicity, and maximizing infection control.

### What you need to know A 42 year old man visits his general practitioner with a three month history of intermittent nausea and central chest discomfort, particularly after fatty and sweet meals. He occasionally has a bad taste in his mouth when he wakes up from sleep. His body mass index is 32, he has no significant medical history, and he takes no regular medications. After asking him about alarm symptoms, you make a diagnosis of gastro-oesophageal reflux disease. You are considering prescribing a proton pump inhibitor as a first line therapy. Prevalence of proton pump inhibitor (PPI) use is about 15% of the UK population, according to two primary care database studies.12 In 2022-23, 73 million NHS prescriptions for PPIs were dispensed in England at a cost of about £190 million, equating to 1.8% of total primary care prescription costs and 6% of all prescriptions dispensed.3 The two most commonly prescribed PPIs in England are omeprazole and lansoprazole, which were among the five most commonly dispensed drugs in 2020. There is strong evidence to support the use of PPIs across a range of indications.4 PPIs are used in the treatment of upper gastrointestinal disorders characterised by excessive acid production and damage to upper gastrointestinal tissue,5 and are also prescribed as gastroprotection for patients being treated with medications which increase the risk of ulceration, such as non-steroidal …

Learn what a long-term study on antibiotic resistance in patients with periodontitis showed, and its implications for dentistry.

Antimicrobials such as clindamycin, cephalosporins, penicillins, and fluoroquinolones have been linked with causing C diff infection in prior research.

Doxycycline is associated with a lower risk of CDI compared to azithromycin when used for atypical coverage in CAP. Thus, patients who are at such risk may benefit from doxycycline as a first-line agent for atypical coverage, rather than the use of a macrolide antibiotic, if Legionella is not of con …

Nature Medicine - A low rate of Clostridioides difficile transmission within an intensive care unit supports the effectiveness of prevention practices and highlights the greater risk to carriers of...

A new study on Clostridioides difficile infections finds that choosing an alternative antibiotic for high-risk patients with pneumonia can reduce infection risk.

A new study published today in the American Journal of Infection Control (AJIC) reveals that the use of doxycycline may help protect against Clostridioides difficile (C. diff) infection for some patients ...

This form of stewardship can reduce unnecessary antibiotic prescribing, reduce costs, and optimize patient outcomes.

Linda Stein Gold, MD, discusses the notable transition in topical therapies for both psoriasis and atopic dermatitis, with the introduction of effective FDA-approved nonsteroidal treatments.

This class of medications were associated with a greater risk of Clostridioides difficile infection (CDI).

A case-control study from the US quantified the risk of Clostridioides difficile infection following a recent antibiotic prescription. It found a 20-fold variation across antibiotic classes and only slightly less variation across individual antibiotics within classes. Clindamycin and later generation cephalosporins carried the greatest risk for C difficile infection, while tetracyclines hardly increased risk at all ( Open Forum Infect Dis doi:10.1093/ofid/ofad413). People who said they were lonely at the time of recruitment into the UK Biobank study were more likely to develop incident Parkinson disease over 15 years of observation. The association was only slightly diminished after adjustment …

The investigational treatment is being developed for this patient population.

•The rate and severity of Clostridioides difficile infection (CDI) has increased throughout North America, the United Kingdom, and Europe. •Scattered evidence about the association of CDI with antidepressant medications use exists in the literature so far. What are the new findings: •The risk of Clo …

Twice-daily cephalexin is as effective as 4-times-daily dosing for uUTI. A twice-daily dosing strategy may improve patient adherence.

This quality improvement project aimed to reduce institutional incidence of Clostridioides difficile infection (CDI) following autologous stem cell transplantation. CDI incidence per transplant was .17 in a baseline period and .09 following the implementation of postdischarge ultraviolet room …

High-dose oral beta-lactams were as safe and effective as oral FQ or TMP/SMX for the treatment of bacteremia from a urinary source. Most patients received 8-10 days of therapy in both groups.

Using threshold logistic analysis, critical incidence levels and antibiotic use targets to control HOHA CDI were determined. Threshold logistic models can be used to inform and enhance the effective design and implementation of antimicrobial stewardship programs.

Rationale Rapid respiratory viral panel (RVP) testing has become widely used to aid in the diagnosis and treatment of acute respiratory failure. However, the impact of RVP on antibiotic stewardship in critically ill patients is unclear. Objective To assess if adoption of RVP testing at hospitals was …

The rising incidence of hospital- and community-acquired Clostridioides difficile infection (CDI) reinforces the need for more-effective prevention.

Antimicrobials such as clindamycin, cephalosporins, penicillins, and fluoroquinolones have been linked with causing C diff infection in prior research.

ClinicalTrials.gov NCT05568654 . Registered on October 4, 2022.

Anti-inflammatory drugs including corticosteroid therapy may worsen the incidence and severity of CDI in this mouse model. These studies may have important clinical implications for understanding the role of anti-inflammatory/ corticosteroid therapy in CDI and inflammatory bowel disease management.

In study findings “discordant with medical clinician prescribing trends,” the dental antibiotic prescribing rate in the US was unchanged over a seven-year period. Learn more.

Study results suggest the greatest risk for Clostridioides difficile infection was observed with use of clindamycin while the lowest risk was observed with doxycycline and minocycline.