User:Deshtalin/sandbox

User:Deshtalin/sandbox

Patients being treated with antibiotics when symptoms begin should stop taking them, if possible. This break in antibiotic therapy can sometimes lead to spontaneous resolution of symptoms. Patients that don't respond to the cessation of broad-spectrum antibiotics will need to be treated with antibiotics capable of killing C. difficile spores. Primary infections are typically treated with metronidazole. This medication is normally given 3 times a day orally and should be taken for a minimum of 10 days. Some patients can't tolerate the side effects of metronidazole, which include severe nausea and vomiting, which can lead to dehydration. In this case, patients should be given oral vancomycin, usually at a dosage of 125 milligrams every 6 hours.

About 20% of patients who successfully complete therapy of primary infection with metronidazole or vancomycin will experience a relapse. A fraction of those patients will experience continuous reoccurrences of the infection. The first relapse of a C. difficile is usually treated with the same antibiotic used to treat the primary infection. Any subsequent infections should not be treated with metronidazole. Occasionally, a standard 10 day course of oral vancomycin will not work. In these cases, a vancomycin taper is the preferred treatment. Patients will take decreasing doses of vancomycin over a period of up to 3 months, depending on the severity of the infection.

Each subsequent relapse of C. difficile tends to be more severe than previous infections. Long term treatment with a vancomycin taper supplemented with probiotics, especially Saccharomyces boulardii, is associated with a higher rate of success.

After three relapses, patients may be treated with oral fidaxomicin, a narrow spectrum antibiotic. The usual dosage is 200 mg twice a day orally for 10 days. Fidaxomicin is considered to be superior to vancomycin for severe CDI. The major downside of treatment with fidaxomicin is the cost of medication. A 10-day course may cost up to 3500 USD.

Patients that do not respond to traditional antibiotic therapy may be eligible for a fecal transplant. Healthcare providers can transfer stool from a healthy person to the colon of a patient with repeated C. difficile infections. This process is the most successful treatment for severe CDI with a cure rate of around 93%. Long term effects of fecal transplantation are unknown, as the procedure has only been FDA approved since 2011 and relatively few procedures have been performed. If transplantation is not an option, removal of the infected part of the colon can cure C. difficile.