In the recent Medical Letter article on the treatment of Clostridium difficile–associated disease (CDAD) we wrote: “Healthcare workers caring for patients with C. difficile infection should follow contact isolation precautions, especially use of gloves and hand washing with soap and water after glove removal. Alcohol-based products such as hand sanitizers will not eradicate C. difficile spores.”1 One reader pointed out that alcoholbased products do eradicate some C. difficile spores and have been invaluable against other pathogens.

In an unpublished study available as an abstract, both alcohol-based hand gels and chlorhexidine washes reduced the number of C. difficile spores on contaminated hands, but chlorhexidine was more effective (8 spores/cm2 remaining vs. 30-44 spores/cm2 with 3 formulations of alcohol-based hand gels).2 A previous study showed that chlorhexidine was not different from soap in removal of spores.3 Alcohol itself should have no effect on spores (purified spores are frequently stored in alcohol), but the mechanical action of washing hands with alcohol-based products may be effective in removing them. The CDC has recommended that healthcare workers caring for patients with known or suspected CDAD use contact precautions and perform hand hygiene with either an alcohol-based hand rub or soap and water, except in an outbreak setting, where exclusive use of soap and water should be considered.4

1. Treatment of Clostridium difficile–associated disease (CDAD). Med Lett Drugs Ther 2006; 48:89.

2. J Leischner et al. Effect of alcohol hand gels and chlorhexidine hand wash in removing spores of Clostridium difficile (CD) from hands. Intersci Conf Antimicrob Agent Chemother (ICAAC), Washington, DC 2005, abstract LB-29-2005.

3. K Bettin et al. Effectiveness of liquid soap vs. chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol 1994; 15:697.

4. CDC. Clostridium difficile information for healthcare providers (www.cdc.gov/ncidod/dhqp/id_CdiffFAQ_HCP.html; accessed January 22, 2007).

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Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table below lists first-choice and alternative drugs for most parasitic infections. The brand names and manufacturers of the drugs are listed in this article.

Superseded--purchase updated Parasitic Infections article
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites.

Note: Drugs for Parasitic Infections, revised and updated, is now available to both subscribers and nonsubscribers on our web site. This article, a bi-annual feature of The Medical Letter for many years, will not be published as a printed issue in 2002, but is included in the 16th edition of The Medical Letter Handbook of Antimicrobial Therapy. The handbook is now available and can be ordered by calling customer service at 1-800-211-2769.

(Superseded by the 2013 version. Click here to purchase.)
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table lists first-choice and alternative drugs for most parasitic infections.