CDI Management in Health Care Systems

Segment Description: Nimish Patel, PharmD, PhD, associate professor, Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, discusses the updates to CDI management guidelines and the role of the pharmacists in providing education to physicians.

“Clostridium difficile infection (CDI) management is a very timely issue. We have had a new set of guidelines come out about 3 months ago, and within the new guidelines there have been a number of updates including the first-line agents as well as the doses to use certain agents at. I think the biggest thing for pharmacists to consider are the agents themselves, so we have fidaxomicin or oral vancomycin and metronidazole was downgraded as a first-line agent, so now, it’s really just a matter of oral vancomycin and fidaxomicin.

The other change in the guidelines that I thought was unique and pertinent to pharmacists was the dose of oral vancomycin. I think in historic iterations of the guidelines, there have been various doses recommended, but the most recent guidelines have recommended 125 milligrams versus some of the other doses that have been used previously. And so, it will be interesting to see how this affects practice—especially since the use of vancomycin, relative to fidaxomicin requires a taper and a little bit more intensive management than fidaxomicin—and with the dosing, it will be interesting to see how that affects outcomes, if at all.

I think that pharmacists play an important role in health care systems, not only for medication management but also for providing education. I think oftentimes you’re dealing with providers that are stretched very thin and may not have time to read the most recent latest and greatest—not that pharmacists have all that extra time on their hands either—but I think we’re a little bit more accessible in terms of providing education to the health staff and throughout the hierarchy of medicine. I think a huge role for pharmacists [is] to educate physicians about some of the changes and help them implement them.

Pharmacists are also important for policy within a hospital setting—getting involved in the hospital pharmacy and therapeutics (P&T) committee [and] working different policies through that are consistent and concordant with the guidelines.

I think one thing that would be helpful would be to be involved in risk stratification and identify those patients who are at a high risk for deleterious outcomes associated with CDIs. We know that fidaxomicin, particularly in certain populations, may have a benefit over some of the traditional standard of care, and so, that’s one quick tip that I think pharmacists can help aid in.

And post discharge when patients are treated, we do have agents that are approved for preventing recurrence all together and considering the patients that should receive those agents.”