What should be considered in making treatment decisions in Clostridium difficile (C diff) infection (CDI)?

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
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Answer

The decision to treat C difficile infection (CDI) and the type of therapy administered depend on the severity of infection, as well as the local epidemiology and type of C difficile strains present. Except for perioperative prophylaxis, it is recommended that the use of cephalosporin and clindamycin be restricted for infection prevention. [5] No treatment is necessary for asymptomatic carriers.

In patients with severe or complicated CDI, oral vancomycin is recommended as first-line therapy due to faster symptom resolution and fewer treatment failures than when metronidazole is used.

Fecal microbiota transplantation (FMT) is recommended for patients with multiple recurrences of CDI whose conditions persist despite appropriate antibiotic treatments. [46, 47] A 2018 systematic review and meta-analysis comprising 7 studies with 543 patients with recurrent CDI that compared FMT to standard-of-care management found FMT to hold promise as a treatment modality in this setting relative to medical therapy alone. [48]  There was no significant difference regarding different forms (fresh vs frozen) and routes (upper vs lower) of FMT administration.

New approaches to the prevention and management of CDI continue to undergo development and investigation. [49]  See the Guidelines section for recent treatment recommendations.


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