GI, Improving Outcomes

Are you doing all you can to fight C.Diff?

Its new provider time in the ED! Rather than focus on something cutting edge, lets go back to basics and talk about something we write for just about every shift: antibiotics.

Specifically, the risk of C. difficile and its association with antibiotics. Approximately 1 % of all admitted patients, 13 % of patients with stays up two 2 weeks, and 50% of patients with stays >4 weeks contract symptomatic, need-to-be-treated, (and sometimes need to be admitted), C diff.

ED favorites, such as cephalosporins, fluoroquinolones, and MRSA fighting clindamycin have been heavily implicated.

A 2012 meta-analysis was done looking at 20 trials and including almost 4000 patients. Probiotics of any sort reduced the relative risk of Cdiff by 66% ie, NNT 30. Total adverse events with probiotics- 9.3% vs 12.6% without.

Given that many stock discharge instructions encourage patients to stop smoking, wear seatbelts, or have CHF-related diet modifications (despite whether or not they smoke, drive, or have CHF!), I see no reason why you could not add a blurb to your discharge instructions about adding a probiotic to their diet while on antibiotics. Probiotics- at $15 for 90 tabs- wont break the bank either. So, while the NNT could be better, its a cheaper option than PO flagyl, a repeat ED visit, and time off from work.

 

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PMID: 23362517

http://www.aafp.org/afp/2005/0301/p921.html

http://www.medscape.com/viewarticle/545269

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