Probiotics for the Prevention and Treatment of Clostridium difficile in Older Patients

Jasmin Islam; Jonathan Cohen; Chakravarthi Rajkumar; Martin J. Llewelyn


Age Ageing. 2012;41(6):706-711. 

In This Article

Management of CDI

Metronidazole and vancomycin remain first-line treatment. In fulminant disease, colectomy may be required, although pooled intravenous immunoglobulin has been used in refractory cases.[19] Disease recurrence is a major challenge affecting around 20–30% of patients despite successful initial treatment with metronidazole or vancomycin.[20] Faecal transplantation may have a role in patients experiencing multiple recurrences.[21] Recent data indicate that many recurrences are indeed new infections in a patient who has remained susceptible rather than true recurrence of the same strain, further emphasising the importance of patient susceptibility in this setting.[22]

Fidaxomicin is a non-absorbable macrocyclic antibiotic that is now licenced in Europe and the USA for severe CDI. Fidaxomicin appears to have less effect on the gut microflora than vancomycin or metronidazole and in a phase 3 non-inferiority study showed equivalent clinical cure and a 45% relative reduction in the relapse rate compared with vancomycin.[23]