Are Antimotility Agents Safe for Use in Clostridioides difficile Infections? Results From an Observational Study in Malignant Hematology Patients

Abstract

Objectives: To evaluate the safety of antimotility agents (AAs) in a population of patients with hematologic malignancies and concurrent Clostridioides difficile infection (CDI) and to describe the outcomes of AA use in a hospital setting. Patients and Methods: We used the electronic health record to identify patients who were hospitalized in the adult malignant hematology service who had 1 or more toxin-positive C difficile stool assay between April 1, 2012, and September 21, 2017. We reviewed medical charts to obtain information on the use of AAs and any subsequent gastrointestinal complications. Results: There were 339 patients who were stool toxin positive for CDI during the study period. Of those, 94 patients (27%) were prescribed AAs within 14 days of CDI diagnosis. All patients received CDI antimicrobial therapy within the first 24 hours. There were 2 adverse gastrointestinal events in the group that received AAs and 6 in the group that did not receive AAs. The risk of adverse events did not differ between patients who received AAs and those who did not (adjusted odds ratio, 0.36; 95% CI, 0.06 to 2.10). The mean age of the full cohort was 52.7AE15.5 years, and the mean length of stay was 26.7AE22.6 days. Early AA use (<48 hours of diagnosis) was not associated with increased adverse effects. Conclusion: There was no increase in the incidence of gastrointestinal events in the arm that used AAs compared with the control arm. The evidence suggests that for patients with hematologic malignancies and CDI, the addition of AAs to appropriate antimicrobial therapy poses no additional risk.

Clinical Practice Guidelines of the Scientific Society for the Clinical Study of Human Microbiome, of the Russian Gastroenterological Association and the Russian Society for the Prevention of Noncommunicable Diseases on the Diagnosis and Treatment of <i>Clostridioides difficile</i> (<i>C. difficile</i>)-associated Disease in Adults

“…Комментарии: использование препаратов, замедляющих моторику толстой кишки, не рекомендуется ввиду риска развития осложнений, таких как дилатация толстой кишки, перфорация и, соответственно, повышение уровня смертности. Несмотря на то что по результатам Рос журн гастроэнтерол гепатол колопроктол 2023; 33(3) / Rus J Gastroenterol Hepatol Coloproctol 2023; 33 (3) Клинические рекомендации/Clinical guidelines нескольких когортных исследований не было значимого повышения риска осложнений при применении данных препаратов, а также отсутствуют проспективные и рандомизированные исследования, в международных клинических рекомендациях не рекомендован прием препаратов, замедляющих моторику у пациентов с C. difficile-ассоциированной болезнью [34].…”

Clostridium difficile in Oncology Patients—Review of Diagnosis and Management in the Indian Setting

“…In a retrospective study of 339 patients with hematological malignancies who had CDAD, it was found that the addition of antimotility agents to appropriate antimicrobial therapy does not pose any additional risk. 30…”