How do you manage a Glucose Dehydrogenase (GDH) positive stool?

From the Guidelines

Management of a GDH positive stool requires a two-step testing algorithm, starting with a toxin assay to confirm active infection, and treatment should be initiated based on severity, with oral vancomycin 125 mg four times daily for 10-14 days being the preferred treatment for severe cases, as recommended by the most recent guidelines 1. When a stool sample is GDH positive, it indicates the presence of C. difficile bacteria, but doesn't confirm active infection. The next step is to perform a toxin assay to determine if the C. difficile is producing toxins.

• If the toxin test is positive, treatment should be initiated based on severity: + For mild to moderate cases, oral metronidazole 500 mg three times daily for 10-14 days may be considered, but oral vancomycin is generally preferred due to its superior efficacy 1. + For severe cases or those unresponsive to metronidazole, oral vancomycin 125 mg four times daily for 10-14 days is the recommended treatment. + For fulminant cases, consider vancomycin 500 mg four times daily plus intravenous metronidazole 500 mg every 8 hours. During treatment, it is essential to:
• Discontinue unnecessary antibiotics if possible
• Avoid antimotility agents
• Implement contact precautions The patient should be monitored for clinical improvement within 48-72 hours of starting therapy. GDH testing is highly sensitive but not specific for toxigenic C. difficile, which is why the two-step testing algorithm (GDH followed by toxin assay) is used to avoid unnecessary treatment of colonized patients without active infection, as supported by the guidelines from the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) 2. In cases of multiple recurrences or severe CDI, alternative treatments such as fecal microbiota transplantation (FMT) or coadjutant treatment with monoclonal antibodies (bezlotoxumab) may be considered, as suggested by recent studies 1.

From the FDA Drug Label

Since the provided drug labels do not directly address the management of a GDH positive stool, the information cannot be used to answer the question.

The FDA drug label does not answer the question.

From the Research

Management of GDH Positive Stool

To manage a GDH positive stool, which is an indicator of Clostridioides difficile infection (CDI), several treatment options are available. The choice of treatment depends on the severity of the infection, the presence of concomitant antibiotics, and the patient's medical history.

• Treatment Options: + Fidaxomicin: This antibiotic has been shown to be effective in treating CDI, especially in patients at risk of relapse 3, 4. + Vancomycin: This is another commonly used antibiotic for treating CDI, and it is often considered the first-line treatment 5, 4. + Metronidazole: This antibiotic is also used to treat CDI, although its effectiveness may vary depending on the severity of the infection and the presence of concomitant antibiotics 6. + Faecal microbiota transplantation: This treatment involves transplanting healthy gut bacteria into the patient's colon to restore the balance of the gut microbiome, and it has been shown to be effective in treating recurrent CDI 5, 7.

Considerations for Concomitant Antibiotics

When managing a GDH positive stool, it is essential to consider the use of concomitant antibiotics, as these can affect the treatment outcome.

• Concomitant Antibiotic Use: The use of concomitant antibiotics can compromise the initial response to CDI therapy and the durability of the response 3.
• Fidaxomicin vs. Vancomycin: Fidaxomicin has been shown to be more effective than vancomycin in achieving clinical cure in the presence of concomitant antibiotic therapy 3.

Special Considerations

In certain patient populations, such as those with inflammatory bowel disease, the treatment of CDI may require special consideration.

• Inflammatory Bowel Disease: Fidaxomicin has been shown to be effective in treating CDI in patients with inflammatory bowel disease, although the response rate may be lower than in other patient populations 7.