*EMBARGOED All research presented at the ACG Annual Scientific Meeting is strictly embargoed until Monday, October 17, 2016 at 8:00 am EDT.

Dr. Elizabeth John
Elizabeth S. John, MD

Poster 893 Clostridium difficile Infections in the Setting of Chronic Opioid Use: Do Pain Medications Actually Worsen Infections?

Author Insight from Elizabeth S. John, MD, Rutgers Robert Wood Johnson Medical School

What’s new here and important for clinicians?

There are four main points I hope clinicians can take away from this pilot study:

  1. As I detail in a recently published review on opioid-induced constipation, opiates cause delayed transit time of the bowel, creating a more conducive setting for bacterial epithelial penetration and local microbial proliferation. This prolongs the toxic manifestations of bowel infections.
  2. Guidelines currently suggest that vancomycin enemas should be used in patients in whom oral antibiotics may not be able to reach the colon, such as those with Hartman’s pouches, ileostomies and colon diversions. Patients on high doses of opioids should be preemptively started on vancomycin enemas as well to facilitate the administration of vancomycin to the affected area.
  3. To reduce lengths of stay, it is crucial for clinicians to recognize severe opioid use as a risk factor for developing worse Clostridium difficile infections, especially in those already taking other antibiotics and acid suppressants.
  4. Lastly, this was a study based on a patient that I encountered during my clinical practice who was on a large dose of methadone. She developed a severe course of Clostridium difficile infection that was complicated by an ileus, an ICU admission. After tapering the dose of methadone, utilizing rectal vancomycin in addition to IV flagyl and PO vancomycin, she started to clinically improve.

What do patients need to know?

Generally, it is important to minimize opioid use for numerous reasons, one reason being it can slow the motility of the GI tract which causes the discomfort of constipation, the presence of ileus in which the gut cannot contract normally, and the prolonging the toxic effects of bowel infections. Clostridium difficile, a toxin-producing bacteria, can cause mild diarrhea to fatal colitis. The research presented here purports that chronic opioid use predisposes patients to severe Clostridium difficile infections. As Clostridium difficile infections can lead to potentially fatal complications, every measure to ensure proper and efficacious treatment should be taken, including discontinuing or tapering medications such as anti-motility agents like opioids, which can further exacerbate the infection.

Read the Abstract

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Author Contact

Elizabeth S. John, MD, Rutgers Robert Wood Johnson Medical School

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