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Line 37:
Line 37: − *First line treatment+ − *Disease stratification+ − *Newer treatments+ − **Fidazomicin (87.7% success rate vs. 86.8% for vanco, 15.4% recurrence rate)+ − ***Expensive+ − **Fecal microbiota transplant (83-94% success rate for recurrent COL). Fecal microbiota transplantation restores gut microbiota diversity, with the+
→TREATMENT
=TREATMENT=
=TREATMENT=
==First line treatment==
*PO Vancomycin (78.5% success rate, 25,3% recurrence rate)
*PO Vancomycin (78.5% success rate, 25,3% recurrence rate)
*PO Metronidazole (66,3% success rate, 47% recurrence rate), recent strains have higher MIC
*PO Metronidazole (66,3% success rate, 47% recurrence rate), recent strains have higher MIC
==Disease stratification==
*WBC (15), Cr (1.5% baseline), recurrence, hypotension, ileus, megacolon
*WBC (15), Cr (1.5% baseline), recurrence, hypotension, ileus, megacolon
*Mild = Metronidazole, preferred for cost and non-inferiority in mild disease
*Mild = Metronidazole, preferred for cost and non-inferiority in mild disease
*Severe/Complicated = Vancomycin
*Severe/Complicated = Vancomycin
*Recurrent = Metro or Vanco for first recurrence, Vanco for subsequent
*Recurrent = Metro or Vanco for first recurrence, Vanco for subsequent
==Newer treatments==
*Fidazomicin (87.7% success rate vs. 86.8% for vanco, 15.4% recurrence rate)
**Expensive
*Fecal microbiota transplant (83-94% success rate for recurrent COL). Fecal microbiota transplantation restores gut microbiota diversity, with the
instillation of donor stool into the gastrointestinal tract of an infected patient, This procedure has had good clinical response without reports of adverse events, for refractory or recurrent COI. The first systematic revien was published in 2911 and
instillation of donor stool into the gastrointestinal tract of an infected patient, This procedure has had good clinical response without reports of adverse events, for refractory or recurrent COI. The first systematic revien was published in 2911 and
included 317 patients with recurrent COI treated with fecal microbiota transplantation via enema, nasojejunal-tube/gastroscope or colonoscopy. Clinical resolution occurred in 92% of patients (89% after a single treatment), without serious adverse effects. A recent revien of 536 patients reported a 27% clinical response rate.
included 317 patients with recurrent COI treated with fecal microbiota transplantation via enema, nasojejunal-tube/gastroscope or colonoscopy. Clinical resolution occurred in 92% of patients (89% after a single treatment), without serious adverse effects. A recent revien of 536 patients reported a 27% clinical response rate.