Aktualizovaný doporučený postup pro léčbu nemocných s kolitidou vyvolanou Clostridioides difficile
| Title in English | Updated Czech guidelines for the treatment of patients with colitis due to Clostridioides difficile |
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| Authors | |
| Year of publication | 2022 |
| Type | Article in Periodical |
| Magazine / Source | Klinická mikrobiologie a infekční lékařství |
| MU Faculty or unit | |
| Citation | |
| Web | https://www.trios.cz/ostatni/odborne-casopisy/kmil/#rocniky |
| Keywords | Clostridioides difficile infection; vancomycin; fidaxomicin; metronidazole; fecal microbiota transplant |
| Description | The actualized Czech guidelines differ in some aspects from the guidelines issued by the ESCMID Study Group for Clostridium difficile that was published in 2021. The main outputs of this Czech recommendations can be summarized in the following points: • The drug of choice for hospitalized patients is orally administered fidaxomicin or vancomycin. In outpatient patients with a mild first episode of CDI, metronidazole can also be used. • If the response of patients to treatment is good and there are no complicating circumstances, the antibiotic treatment can be reduced (e.g. with fidaxomicin to 5 days, analogously, treatment course with vancomycin can be reduced to 6-7 days). • If oral therapy is impossible, the drug of the first choice is tigecycline, 100 mg i.v., b.i.d., with an initial shortening of the interval between the first and the second doses for faster saturation. As the severity of the disease progresses during this antibiotic treatment, it is necessary to build access to the ileum or cecum, i.e. to perform double ileostomy or percutaneous endoscopic cecostomy, and to apply vancomycin or fidaxomicin lavages into the resulting inputs. • Fulminant clostridial colitis should be treated by fidaxomicin p.o. ± tigecycline i.v. If peristalsis ceases, fidaxomicin should be administered into the ileum or cecum by artificially created access, see above. If sepsis develops, a broad-spectrum beta-lactam antibiotic (piperacillin/tazobactam, carbapenem) i.v. is added to topically administered fidaxomicin instead of i.v. tigecycline; at the same time, colectomy should be considered as an ultimatum refugium. • In the treatment of the first recurrence, fidaxomicin or vancomycin is administered with a subsequent faecal microbiota transplant (FMT) from a healthy donor. In the second or subsequent recurrence, administration of fidaxomicin is of little benefit; the therapy of choice is oral vancomycin and subsequently FMT. Prolonged therapy with vancomycin or fidaxomicin in a decreasing mode (taper, pulse) is appropriate only when FMT could not be performed. The recommended procedure was reported and defended at the Annual Meeting of Heads of Infectious Disease Departments in the Czech Republic. |