From Megan Von Isenburg, DUH Medical Librarian:
Don’t forget to check Custom ID for the Duke guidelines. You can get to it from Clinical Tools, Virtual PIN, or by typing Custom ID into the URL bar. Here’s a direct link – http://customid.duhs.duke.edu/DukeMed/DUH/Index.asp
To find the best evidence/literature –
- Be sure not to search for just c diff. It doesn’t map to the official heading clostridium difficile, and you miss most articles. Remember, you can always check details to determine if you found articles with the right heading.
- For articles on a specific drug, a simple clostridium difficile AND cholestyramine or clostridium difficile AND fidaxomicin or even clostridium difficile AND fecal transplantwill pull up articles on those specific drugs.
- If you don’t want to commit to a management strategy yet, but want to find any good evidence for treatment of refractory c diff, you need to consider the various ways authors might say refractory. Something like clostridium difficile AND (refractory OR failure OR resistant) might do the trick well enough – then just click on Therapy/Treatment to see RCTs or Systematic Reviews to see SRs and meta-analyses.
- Similarly, articles on recurrent c diff would be found here – clostridium difficile AND (recurrent OR recurrence)
There’s a nice comparative effectiveness review in Annals: Drekonja DM, Butler M, MacDonald R, Bliss D, Filice GA, Rector TS, Wilt TJ. Comparative effectiveness of Clostridium difficile treatments: a systematic review. Ann Intern Med. 2011 Dec 20;155(12):839-47. Review. PubMed PMID: 22184691.
The closest we got to a definition of treatment failure was 6 days, from this recent systematic review: Vardakas KZ, Polyzos KA, Patouni K, Rafailidis PI, Samonis G, Falagas ME. Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence. Int J Antimicrob Agents. 2012 Jul;40(1):1-8. Epub 2012 Mar 6. Review. PubMed PMID: 22398198.