{"id":843,"date":"2010-03-31T14:26:57","date_gmt":"2010-03-31T18:26:57","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=843"},"modified":"2015-06-04T15:25:31","modified_gmt":"2015-06-04T19:25:31","slug":"c-diff-guidelines-metronidazole-still-preferred","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/c-diff-guidelines-metronidazole-still-preferred\/2010\/03\/31\/","title":{"rendered":"C diff Guidelines:  Metronidazole Still Preferred?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-844\" title=\"C Diff image 2\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2010\/03\/C-Diff-image-21.jpg\" alt=\"C Diff image 2\" width=\"210\" height=\"210\" \/>IDSA and\u00a0The Society for Healthcare Epidemiology of America (SHEA) have published <a href=\"http:\/\/www.journals.uchicago.edu\/doi\/full\/10.1086\/651706\" target=\"_blank\">Clinical Practice Guidelines for <\/a><em><a href=\"http:\/\/www.journals.uchicago.edu\/doi\/full\/10.1086\/651706\" target=\"_blank\">Clostridium difficile<\/a><\/em><a href=\"http:\/\/www.journals.uchicago.edu\/doi\/full\/10.1086\/651706\" target=\"_blank\"> infection<\/a>.<\/p>\n<p>Not surprisingly, it&#8217;s a comprehensive, extensively-referenced document that will be an invaluable resource, especially since the previous version is approximately 15 years old.<\/p>\n<p>But with the caveat that I&#8217;m not an expert in this area, these particular treatment recommendations continue to perplex me:<\/p>\n<blockquote><p>Metronidazole is the drug of choice for the initial episode of mild\u2010to\u2010moderate\u00a0<em>Clostridium difficile<\/em> infection (CDI). The dosage is 500 mg orally 3 times per day for 10\u201314 days.<\/p>\n<p>Vancomycin is the drug of choice for an initial episode of severe CDI. The dosage is 125 mg orally 4 times per day for 10\u201314 days.<\/p><\/blockquote>\n<p>In what other diseases do we recommend something different for mild vs. severe infection, when both are oral options? \u00a0I understand there is a cost difference, but since the data on treatment of severe CDI demonstrate the superiority of vancomycin, is this the right approach? \u00a0Especially since oral vancomycin is better tolerated?<\/p>\n<p>Or are we still going through this <a href=\"http:\/\/www.journals.uchicago.edu\/doi\/full\/10.1086\/430317\" target=\"_blank\">widely-quoted (and frankly kind of \u00a0politically incorrect!) mom vs mother-in-law dilemma?<\/a><\/p>\n<p>With the intention of being\u00a0provocative, what would <em>you <\/em>take if <em>you <\/em>had <em>C diff?<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>IDSA and\u00a0The Society for Healthcare Epidemiology of America (SHEA) have published Clinical Practice Guidelines for Clostridium difficile infection. Not surprisingly, it&#8217;s a comprehensive, extensively-referenced document that will be an invaluable resource, especially since the previous version is approximately 15 years old. But with the caveat that I&#8217;m not an expert in this area, these particular [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8,9],"tags":[131,203,462,613,971],"class_list":["post-843","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","category-policy","tag-c-diff","tag-clostridium-difficile","tag-hospital-epidemiology","tag-metronidazole","tag-vancomycin"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/843","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=843"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/843\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=843"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=843"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=843"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}