Methods: A self-administered case-based questionnaire was developed to characterize prescribing practices for CDAD in H/O patients. Hypothetical case scenarios were provided to assess variables influencing treatment choices (WBC, SCr, recent cancer treatment, stool volume) The questionnaire was sent to H/O and infectious diseases (ID) specialty pharmacists through professional organization email lists.
Results: The survey was sent to 2923 pharmacists. At interim analysis, 108 pharmacists (56% ID and 39% H/O) completed the survey. A majority (68%) practice at academic medical centers. For uncomplicated first episode of CDAD in solid tumor patients, 72% chose oral metronidazole (M) and 28% chose oral vancomycin (V). These were equally prescribed for uncomplicated recurrence. For initial episode CDAD in neutropenic post-hematopoietic stem cell transplant (HSCT) patients, 60% chose oral V, but oral M (20%), oral V plus IV M (15%) and fidaxomicin (F; 5%) were also selected. Increased SCr in HSCT patients altered treatment choices to 71% oral V, 11% F and only 9% oral M. Recurrences in hematologic cancer patients were treated with oral V (74%), F (29%), and oral M (2%). For persistent CDAD (continued symptoms 5 days after beginning treatment), oral V was the predominant agent (69%) followed by F (29%).
Conclusion: Choices for CDAD were diverse and not always consistent with the IDSA/SHEA guidelines. Differences in treatment choices were influenced by tumor and chemotherapy type, SCr, WBC and severity of CDAD symptoms. CDAD therapy guidelines should be developed specifically for H/O patient populations.
K. Rolek, None
D. Klepser, None
A. G. Freifeld, Merck: Data Safety Monitoring Board , Consulting fee
Astellas: Data Safety Monitoring Board , Consulting fee
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