From the Guidelines
Reglan (metoclopramide) should not be used in the treatment of Clostridioides difficile (C. diff) infection. The primary treatments for C. diff are antibiotics that specifically target the infection, such as oral vancomycin (125 mg four times daily for 10-14 days), fidaxomicin (200 mg twice daily for 10 days), or metronidazole (500 mg three times daily for 10-14 days) for mild cases, as recommended by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) in their 2021 focused update guidelines 1. Reglan is a prokinetic agent that increases gastrointestinal motility and is primarily used for gastroparesis, GERD, or nausea and vomiting. Using Reglan during C. diff infection could potentially worsen symptoms by accelerating intestinal transit time, which might exacerbate diarrhea and spread the infection through the bowel more rapidly. Additionally, Reglan has no antimicrobial properties against C. diff.
The IDSA and SHEA guidelines suggest using fidaxomicin rather than a standard course of vancomycin for patients with an initial C. diff episode, with vancomycin remaining an acceptable alternative 1. For patients with recurrent C. diff episodes, fidaxomicin (standard or extended-pulsed regimen) is suggested rather than a standard course of vancomycin, with vancomycin in a tapered and pulsed regimen or vancomycin as a standard course being acceptable alternatives for a first C. diff recurrence.
Key points to consider in the treatment of C. diff include:
- Discontinuing unnecessary antibiotics that may have triggered the infection
- Proper hydration
- In some cases, probiotics as an adjunctive therapy after consultation with a healthcare provider
- Fidaxomicin or vancomycin as the primary treatment options
- Avoiding the use of Reglan or other prokinetic agents that may exacerbate symptoms.
From the Research
Treatment of C. difficile Infection
There are several treatment options available for C. difficile infection, including:
- Fidaxomicin
- Vancomycin
- Metronidazole
- Combination of vancomycin and metronidazole
Efficacy of Treatment Options
Studies have compared the efficacy of these treatment options, with results including:
- Fidaxomicin was associated with a lower risk of recurrence compared to vancomycin 2
- Fidaxomicin was superior to metronidazole, vancomycin, or their combination for sustained clinical response and prevention of recurrent CDI in the initial episode, first recurrence, and non-severe cases 3
- Fidaxomicin had similar treatment outcomes to vancomycin in severe CDI cases 3
- Vancomycin and metronidazole had low resistance rates, with 1.6% and 2.2% resistance rates, respectively 4
Reglan and C. difficile Infection
There is no direct evidence in the provided studies regarding the use of Reglan in the treatment of C. difficile infection. Reglan (metoclopramide) is typically used to treat gastrointestinal disorders such as gastroparesis, but its use in C. difficile infection is not mentioned in the studies 4, 5, 2, 6, 3.