Prochlorperazine (Compazine) in Patients with C. difficile Infection
Prochlorperazine (Compazine) should be avoided in patients with C. difficile infection as it may mask symptoms, worsen the disease course, and potentially increase mortality and morbidity. 1
Rationale for Avoiding Prochlorperazine in C. diff Infection
- Prochlorperazine has antimotility effects that can lead to prolonged retention of C. difficile toxins in the colon, potentially worsening the infection and increasing the risk of complications 1
- Masking diarrhea symptoms with anti-motility agents like prochlorperazine can delay appropriate diagnosis and treatment of C. difficile infection 1
- Symptom suppression may create a false impression of clinical improvement while allowing the underlying infection to progress 1
Recommended Management Approach for C. difficile
First-line Treatment Options
- For mild-moderate C. difficile infection: Oral vancomycin 125 mg four times daily for 10 days is now preferred over metronidazole 1
- For severe C. difficile infection: Oral vancomycin 125 mg four times daily or fidaxomicin 200 mg twice daily for 10 days 1
- For patients who cannot take oral medications: Vancomycin may be administered as a retention enema via a rectal tube 1
Supportive Care (Without Antimotility Agents)
- Provide intravenous fluid resuscitation to correct volume depletion 1
- Consider albumin supplementation in patients with severe hypoalbuminemia (<2 g/dl) 1
- Correct electrolyte imbalances promptly 1
- Discontinue the inciting antibiotic agent(s) if possible 1, 2
- Discontinue unnecessary proton pump inhibitors as part of good stewardship practice 2
Important Clinical Considerations
- Diarrhea is a key clinical symptom for monitoring treatment response in C. difficile infection; suppressing this symptom with prochlorperazine can make it difficult to assess clinical improvement 1
- Severe C. difficile infection can progress to toxic megacolon, sepsis, or death if not properly managed 1, 3
- Antimotility agents like prochlorperazine have been associated with prolonged symptoms and increased complications in infectious diarrhea 1
- For patients with legitimate antiemetic needs, consider alternative agents with less impact on gut motility after discussing with infectious disease specialists 1, 2
Special Populations
- In patients with inflammatory bowel disease and C. difficile, antimotility agents pose an even greater risk due to the already compromised colonic function 1
- Immunocompromised patients (transplant recipients, cancer patients, HIV/AIDS) are at higher risk for severe C. difficile infection and should especially avoid medications that may mask symptoms or worsen disease 1
- Elderly patients have increased risk for C. difficile treatment failure and should avoid medications that could complicate assessment of treatment response 4, 3
By avoiding prochlorperazine and other antimotility agents in patients with C. difficile infection, clinicians can better monitor disease progression and treatment response, ultimately improving patient outcomes.