Novel Alternative Treatments Offer Promise in Managing Clostridium difficile Infections

Program Description:

The new antibiotic fidaxomicin, fecal microbiota transplantation, and colon-sparing surgery appear to be effective alternatives to standard treatment for Clostridium difficile infections, particularly severe, recurrent cases, according to a report presented here at the 2012 Annual Meeting of the American College of Physicians. Studies have shown that most exposures leading to C difficile infection, which can cause symptoms ranging from diarrhea to severe inflammation of the colon, are associated with contact within healthcare institutions, including hospitals, nursing homes, and outpatient clinics.

Antibiotics such as oral vancomycin or metronidazole are generally used to treat C difficile infections, although the rate of recurrence is high. Two recent clinical trials have compared vancomycin with the new agent fidaxomicin in more than 1,000 adults with acute symptoms of C difficile infection and a positive result on a stool toxin.

Although an older concept for managing intestinal disorders, fecal microbiota transplantation (FMT) is the focus of newer studies for treating recurrent/refractory C difficile infection.

INTENDED AUDIENCE:

Physicians, Nurse Practitioners, Physician Assistants, Nurses, and other healthcare providers who treat patients with Clostridium difficile infections.

Activity Objectives:

After taking part in this educational activity, clinicians should be better able to:

• Analyze the incidence and transmissibility of Clostridium difficile infections


• Evaluate current standard of care and alternative treatment strategies for the management of C difficile infection



Credits	Type	Accreditation Statement	Designation Statement
0.50	AMA PRA Category 1 Credit(s)TM	This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and Haymarket Medical Education. PIM is accredited by the ACCME to provide continuing medical education for physicians.	The Postgraduate Institute for Medicine designates this enduring material for a maximum of .50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty:

Robert G. Uzzo, MD, FACS
Chair of Surgery and the G. Willing "Wing" Pepper Chair in Cancer Research
Fox Chase Cancer Center, Philadelphia
Associate Professor of Urology
Temple University School of Medicine
Philadelphia, PA

Roy C. Blank, MD
Internist and Clinical Nutrition Specialist
Southern Piedmont Primary Care in Monroe, NC
Associate Professor and Medical Director in the Department of Physician Assistant Studies
Wingate University
Wingate, NC

Edith A. Perez, MD
Deputy Director, Mayo Clinic Cancer Center
Group Vice-Chair, Alliance for Clinical Trials in Oncology
Serene M. and Frances C. Durling Professor of Medicine
College of Medicine
Director of the Breast Program, Mayo Clinic
Jacksonville, Florida

Mark A. Socinski, MD
Visiting Professor of Medicine and Thoracic Surgery
Director, Lung Cancer Section, Division of Hematology/Oncology
Co-Director, University of Pittsburgh Medical Center Lung Cancer Center of Excellence
Co-Director, Lung and Thoracic Malignancies Program
Pittsburgh, PA

Disclosures:

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Dr. Uzzo is on the Speaker’s Bureau for Pfizer, Inc.

Dr. Blank has nothing to disclose.

Dr. Perez has nothing to disclose.

Dr. Socinski is on the speaker’s bureau for Genentech and Eli Lilly and Co and receives research grants from Genetech, GlaxoSmithKline, Pfizer and Celgene.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

The following PIM planners and managers, Laura Excell, ND, NP, MS, MA, LPC, NCC; Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CCMEP; Jan Schultz, RN, MSN, CCMEP; and Patricia Staples, MSN, NP-C, CCRN hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following Haymarket Medical Education planners and managers hereby state the following financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months:

Lynne Callea, Vice President, Director of CME & Custom Publishing, Nick Zittell, Vice President, Editorial Director, and Susan Reckling, medical writer, have no real or apparent conflicts of interest to report.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM) and Haymarket Medical Education do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM or Haymarket Medical Education. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Accredited Provider:

This program is jointly sponsored by Postgraduate Institute for Medicine and Haymarket Medical Education.

                 

If you have any questions relating to the accreditation of this activity, please contact information@pimed.com.

Instructions:

To obtain credit, a score of 70% or better is required. This CME is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the posttest survey, and have received your digital copy of your credit certificate. Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.



SYSTEM REQUIREMENTS


WINDOWS PC SYSTEM REQUIREMENTS:
266-MHz Pentium II; Windows 98 or higher; 64 MB RAM; 800 x 600 screen resolution set for “High Color (16-Bit)”; Macromedia Flash Player 6 or higher.

MACINTOSH® SYSTEM REQUIREMENTS:
Power Mac g3 at 300 MHz; System 8.5 or higher (excluding Mac OSX); 96 MB RAM; 20 MB minimum hard disk space available; 800 x 600 screen resolution set to “Thousands of Colors”; Macromedia Flash Player 6 or higher.

SYSTEM REQUIREMENTS:

WINDOWS PC SYSTEM REQUIREMENTS:
266-MHz Pentium II; Windows 98 or higher; 64 MB RAM; 800 x 600 screen resolution set for “High Color (16-Bit)”; Macromedia Flash Player 6 or higher.

MACINTOSH^® SYSTEM REQUIREMENTS:
Power Mac g3 at 300 MHz; System 8.5 or higher (excluding Mac OSX); 96 MB RAM; 20 MB minimum hard disk space available; 800 x 600 screen resolution set to “Thousands of Colors”; Macromedia Flash Player 6 or higher.