Introduction
Etiologic agent
Epidemiology and transmission
Clinical syndromes
Clostridial wound contamination
Polymicrobial infections involving clostridia
| Condition | Antibiotic Treatment | Penicillin Allergy | Adjunctive Treatment/Note |
| Wound contamination | None | — | Treatment should be based on clinical signs andsymptoms as listed below and not solely onbacteriologic findings. |
| Polymicrobial anaerobicinfections involvingclostridia (e.g.,abdominal wall,gynecologic) | Ampicillin (2 g IV q4h) plusClindamycin (600–900 mgIV q6–8h) plus Ciprofloxacin(400 mg IV q6–8 h) | Vancomycin (1 g IV q12h)plus Metronidazole (500 mgIV q6h) plus Ciprofloxacin(400 mg IV q6–8h) | Empirical therapy should be initiated. Therapyshould be based on Gram’s stain and culture resultsand on sensitivity data when available. Add gram-negative coverage if indicated (see text). |
| Clostridial sepsis | Penicillin (3– 4 mU IV q4–6h) plus Clindamycin(600–900 mg IV q6–8h) | Clindamycin alone orMetronidazole (as above) orVancomycin (as above) | Transient bacteremia without signs of systemictoxicity may be clinically insignificant. |
| Gas gangrenea | Penicillin G (4 mU IV q4– 6h) plus Clindamycin(600–900 mg IV q6–8h) | Cefoxitin (2 g IV q6h) plusClindamycin (600–900 mgIV q6–8h) | Emergent surgical exploration and thoroughdebridement are extremely important.Hyperbaric oxygen therapy may be considered axersurgery and antibiotic initiation. |
Enteric clostridial infections
Antibiotic-associated diarrhea without pseudomembranous colitis
Enteritis necroticans
- Caused by ? toxin– and ? toxin–producing strains of C. perfringens type C
Necrotizing enterocolitis
- Associated with C. perfringens type A
Clostridial bacteremia
Clostridial skin and soft-tissue infections
Clostridial myonecrosis (gas gangrene)
- Traumatic
- Spontaneous (nontraumatic)
- Clinical manifestations
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- Treatment
- Debridement (m/i), ?? ?? amputation
- Anti: clindamycin +/- penicillin G
- Prevention
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