It appears that prescriptions for treating C. diff infections often stray from approved guidelines. Consider this recent study discussed on Medscape.
The investigators examined 2013 and 2014 surveillance data from 11 counties in Maryland. Of the 604 patients with treatment data, 264 were cared for as outpatients.
For those with severe infection, defined as a Charlson score of at least 5, treatment was in compliance in only 13% of cases. In fact, 70% got the wrong drug, and when the right drug was given, half got the wrong dose and 20% got the wrong frequency," Perlmutter said. "This is horrifying to me."
For severe infection, guidelines from the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America (IDSA) recommend vancomycin 125 mg four times per day. And for mild to moderate infection, recommended treatment in IDSA guidelines includes metronidazole 500 mg three times per day.
Wrong Drug, Inappropriate Dosing
The majority of patients in this study, 77%, received metronidazole instead of vancomycin.
For patients treated with vancomycin, 36% received 125 mg four times daily, 43% received 250 mg four times daily, and 5% received doses as high as 500 mg four times daily. In 17% of cases, dose was not indicated.
And it's no wonder that some strains of C. diff have developed antibiotic resistance."Most concerning in terms of outcomes is undertreatment with vancomycin in severe cases," he pointed out.
For inpatients, similar trends have been observed and have been linked to worse outcomes (J Hosp Infect. 2013;85:28-32).
C difficile Prescriptions Often Stray From Guidelines
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