New in the treatment of Clostridium difficile
Fecal examination should only be done for diarrhea, as well as for suspected intestinal obstruction due to C. difficile. A cytopathic test on cell culture is the preferred diagnostic method, since the immunoenzymatic assay of toxins A and B is faster, but less sensitive, and more modern research methods, such as the polymerase chain reaction, are not ready for use in daily practice.
Particular attention should be paid to hand hygiene, since soap and water are more effective than antiseptics containing alcohol. Patients with C. difficile should be isolated as much as possible. If it is impossible to provide a separate room for these patients, they should be separated from the others at a distance of at least 1 meter, and separated by curtains to reduce the likelihood of direct contact, and medical staff and visitors must use medical gloves and gowns.
Systematic screening of asymptomatic patients is not recommended. The use of antibiotics should be minimized to avoid negative effects on the beneficial intestinal microflora, which helps to inhibit the growth of C. difficile. As for probiotics, at the moment there is not enough data to recommend them as prophylaxis.
The use of drugs that suppress peristalsis should be avoided. In case of moderate infection, metronidazole is prescribed at a dose of 500 mg 3 times a day. As a starting treatment for an uncomplicated severe infection, patients should receive 125 mg of vancomycin orally daily. Currently, there is insufficient evidence for the use of combination therapy for uncomplicated infection.
Severe and complicated infections should be treated with high doses of vancomycin - 500 mg 4 times a day and / or metronidazole 500 mg every 8 hours. A total or subtotal colectomy is performed before the serum lactic acid level exceeds 5 mmol / L.
Metronidazole should not be used after the first relapse of the infection has stopped or for more than 14 days. The second and subsequent use of vancomycin indoors should be done with a gradual dose reduction.