What are the ESCMI guidelines for the treatment of 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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In 2013, The European Society of Clinical Microbiology and Infection released updated guidelines for the treatment of CDI, which include antibiotic treatment for all but very mild cases. Recommendations include the following [50, 51] :

  • For patients with nonepidemic, nonsevere CDI clearly induced by antibiotic use, with no signs of severe colitis, it may be acceptable to stop antibiotic treatment and observe the clinical response for 48 hours.

  • Antibiotic treatment is recommended for all except very mild cases actually triggered by antibiotic use; suitable treatments include metronidazole, vancomycin, and fidaxomicin.

  • For mild/moderate disease, oral metronidazole (500 mg 3 times daily for 10 days) is recommended as the initial treatment.

  • In patients for whom oral treatment is inappropriate, fidaxomicin may be used; specific indications include first-line treatment in patients with recurrence or at risk for recurrence.

  • For patients with severe CDI, suitable antibiotic regimens include vancomycin (125 mg 4 times daily for 10 days; may be increased to 500 mg 4 times daily) or fidaxomicin (200 mg twice daily for 10 days).

  • Use of fidaxomicin is not supported in life-threatening CDI.

  • Use of oral metronidazole in severe or life-threatening CDI is discouraged.

  • Fecal transplantation is recommended for multiple recurrent CDI.

  • For patients with colonic perforation and/or systemic inflammation and deteriorating clinical condition despite antibiotic treatment, total abdominal colectomy or diverting loop ileostomy combined with colonic lavage is recommended.

  • Additional management measures include discontinuing unnecessary antimicrobial therapy, adequate replacement of fluids and electrolytes, avoiding antimotility medications, and reviewing the use of proton pump inhibitors.

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