VIDEO: Expert discusses new ACG guidelines, importance of microbiota
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In this video, Paul Feuerstadt, MD, FACG, AGAF, spoke about new changes to the American College of Gastroenterology’s guidelines on Clostridioides difficile infection treatment, which were discussed at the ACG Annual Scientific Meeting.
Based on the new guidelines, treatment for first-time infection should be chosen based on severity, with non-severe cases categorized as a white blood cell count less than 15,000 cells/mm3 and creatinine levels lower than 1.5 mg/dL.
Feuerstadt, assistant clinical professor of medicine at Yale University, also highlighted recommendations for first recurrences, which include vancomycin in a taper/pulse fashion after failed metronidazole, vancomycin and fidaxomicin; fidaxomicin after failed metronidazole and vancomycin; and bezlotoxumab as an add-on for standard-of-care antimicrobial.
“Once our patients get to that second recurrence or third episode, that’s the scenario where we consider 7 to 10 days of antimicrobials followed by fecal microbiota transplantation,” he said.
Feuerstadt also discussed a presentation on the applicability of the microbiota in certain diseases and how best to understand it.
“As we move forward as clinicians, we need to understand that in the C. difficile world, it’s very applicable and in many other worlds, in many other disease states, the future is truly bright,” he said. “But we need to understand the basics in those other states before we can apply those basics as we have in C. difficile infections.”
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