How is Clostridium difficile infection treated?

Clostridium difficile infection (CDI) is a significant healthcare concern, often associated with antibiotic use and characterized by recurrent episodes that challenge effective treatment. The management of CDI has evolved with a focus on restoring the normal intestinal microbiota and using targeted antibiotic therapies.

Fecal microbiota transplantation (FMT) is highly effective for recurrent CDI, with disease resolution in approximately 90% of cases, and is recommended for multiple recurrences .
Duodenal infusion of donor feces has shown to be significantly more effective than vancomycin alone for recurrent CDI, with an 81% resolution rate after the first infusion.
Standard antibiotic treatments include metronidazole for initial non-severe CDI and vancomycin for severe or complicated cases, as well as for multiple recurrences .
Alternative antibiotics such as fidaxomicin, nitazoxanide, and rifaximin have been used successfully for CDI treatment, but clinical experience with these agents is limited .
Probiotics and prebiotics have shown limited efficacy and are not widely recommended for the prevention or treatment of CDI .
For severe cases not responding to medical therapy, surgical interventions such as total abdominal colectomy or diverting loop ileostomy with colonic lavage may be necessary.

In conclusion, the treatment of CDI has diversified beyond traditional antibiotic therapy to include FMT as a cornerstone for recurrent cases. Antibiotics remain the primary treatment for initial episodes, with vancomycin and fidaxomicin as preferred options for severe or recurrent infections. The integration of these treatments aims to reduce the recurrence of CDI and improve patient outcomes.

How is Clostridium difficile infection treated?

Summary

Sources and full results

Duodenal infusion of donor feces for recurrent Clostridium difficile.

Infusion of donor feces is significantly more effective for treating recurrent Clostridium difficile infection than vancomycin alone or with bowel lavage.

Treating Clostridium difficile infection with fecal microbiota transplantation.

Fecal microbiota transplantation is a safe, inexpensive, and effective treatment for Clostridium difficile infection, with about 90% of patients cured.

Treatment of Clostridium difficile infection.

Metronidazole remains the first choice for treating Clostridium difficile infection, with vancomycin recommended for serious cases or multiple recurrences.

European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection.

This update of the ESCMID treatment guidance document for Clostridium difficile infection emphasizes antibiotic treatment, with faecal transplantation recommended for multiple recurrent cases and colonic lavage for severe cases.

Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection.

Intestinal microbiota transplantation (IMT) is highly effective in resolving recurrent Clostridium difficile infection and pseudomembranous colitis, with disease resolution in 92% of cases, but effectiveness varies by route, relationship to stool donor, and treatment before infusion.

Alternative Therapies for Clostridium difficile Infections

Nitazoxanide and teicoplanin show potential as alternatives to traditional treatment for Clostridium difficile infections, while prebiotic formulations for prevention and recurrent infection are not clinically warranted.

Rectal bacteriotherapy for recurrent Clostridium difficile-associated diarrhoea: results from a case series of 55 patients in Denmark 2000-2012.

Rectal bacteriotherapy is a viable alternative to faecal microbiota transplantation for patients with relapsing Clostridium difficile-associated diarrhoea, with 64% of patients not recurring within 30 days of treatment.

Treatment of Clostridioides (Clostridium) difficile infection

Current treatment guidelines recommend vancomycin and fidaxomicin for Clostridioides difficile infection, with metronidazole for mild-to-moderate disease and bezlotoxumab for recurrent infections.

Treatment of Clostridium difficile-associated disease.

Clostridium difficile infection treatment with metronidazole or vancomycin reduces morbidity and mortality, but relapse is common, with antibody development being a critical factor in recurrence.

A Review of the Economics of Treating Clostridium difficile Infection

Cost-effective strategies for preventing Clostridium difficile infection include screening hospital admissions for C. difficile, using vancomycin for moderate to severe cases, and considering fidaxomicin for moderate cases.

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