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C. diff Outbreak and Prescribing Practices
- In 2008, a C. diff outbreak in a small Scottish hospital led to 143 cases and 34 deaths.
- Overprescribing of broad-spectrum antibiotics like ceftriaxone was identified as a key contributing factor, prompting a nationwide shift in prescribing practices.
Empiric Antibiotic Regimen
- For broad-spectrum empiric coverage, consider amoxicillin, gentamicin, and metronidazole.
- This combination covers gram-positives, gram-negatives, pseudomonas, and anaerobes while minimizing C. diff risk.
Impact of Gentamicin on Infection Rates
- Switching to gentamicin as part of first-line treatment in Scotland correlated with lower C. diff, MRSA, and gram-negative sepsis mortality rates.
- The increased complexity of gentamicin dosing may also promote more thoughtful antibiotic prescribing.