Clostridium species

Background:

———————————————————
Anaerobic Gram-positive bacilli
———————————————————
>Clostridium species:
     1] Clostridium difficile
     2] Clostridium perfringens
     3] Clostridium tetani

Clostridium:

  • Gram-positive bacteria, obligate anaerobes capable of producing endospores.
  • Rod-shaped.
  • Consists of approximately 100 known species that include common free-living bacteria as well as important pathogens.
  • There are five main species responsible for disease in humans.
    • C. botulinum: produces botulinum toxin in food/wound and can cause botulism.
    • C. difficile: can flourish when other bacteria in the gut are killed during antibiotic therapy, leading to pseudomembranous colitis.
    • C. perfringens: Causes a wide range of symptoms, from food poisoning to gas gangrene. 
    • C. tetani:  causative organism of tetanus.
    • C. sordellii: can cause a fatal infection in exceptionally rare cases after medical abortions.

Therapy:

Important considerations:  The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions.   Generally, the most common agents/regimens are listed first.   Listed dosages may need to be adjusted for renal dysfunction.

Clostridium difficile:

  1. Metronidazole 500 mg po three times daily or 250 mg four times daily x 10 to 14 days (For initial oral antibiotic treatment of mild to moderate disease only).
  2. Severe disease:  Vancomycin 125 mg orally four times daily x 10 to 14 days (may be increased to 500 mg 4 times daily)  OR   Fidaxomicin 200 mg po bid x 10 days
  3. Pulsed oral vancomycin for relapse e.g.:  125 mg orally four times daily for 7 to 14 days, then 125 mg orally twice daily for 7 days, then 125 mg orally once daily for 7 days, then 125 mg orally every other day for 7 days, and finally vancomycin 125 mg orally every 3 days for 14 days.
  4. Relapse:  Vancomycin 125 mg orally four times daily x 14 days, followed by rifaximin 400 mg bid x 14 days

Clostridium perfringens:

  1. Penicillin G 2-4 million units IV q4-6h +/-  Clindamycin  600mg IV every 6 or 8 hours or 300mg orally four times daily 
  2. Several agents:
  3. Azithromycin
  4. Ampicillin 2 grams IVPB every 4-6 hours
  5. Ampicillin-sulbactam (Unasyn) 1.5 – 3.0 grams ivpb q6h
  6. Cefazolin 1 gram IVPB q8h
  7. Ceftriaxone 1-2 grams IV q24h
  8. Cefepime 2 grams IV every 12 hours
  9. Piperacillin-tazobactam 3.375g ivpb q6h
  10. Doxycycline 100mg orally twice daily
  11. Vancomycin 1 gram  ivpb q12h (patient-specific dosing required)
  12. Linezolid 600 mg orally or IV q 12h
  13. Chloramphenicol 50-100 mg/kg/day in divided doses every 6 hours (Maximum daily dose is 4 grams e.g. 1 gram q6h)
  14. Imipenem 500mg IV every 6 hours.

Clostridium tetani:

  1. Metronidazole 500 mg IV every six to eight hours
  2. Doxycycline 100 mg IV q12h
  3. cefazolin 1 to 2 g IV every eight hours
  4. Ceftriaxone 1-2 grams IV q24h
  5. Vancomycin 1 gram  ivpb q12h (patient-specific dosing required)
  6. Chloramphenicol 50-100 mg/kg/day in divided doses every 6 hours (Maximum daily dose is 4 grams e.g. 1 gram q6h)

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer