Epidemiology, Diagnosis and Treatment of Clostridium Difficile Infection

Matteo Bassetti; Giovanni Villa; Davide Pecori; Alessandra Arzese; Mark Wilcox


Expert Rev Anti Infect Ther. 2012;10(12):1405-1423. 

In This Article


Diagnosis and treatment of CDI represents a challenge to the clinician. As recommended by several guidelines, a key measure for treating CDI ideally includes the discontinuation of concurrent antibiotic therapy to allow the intestinal flora to restore itself; in practice, the patient's clinical condition does not always allow this. Another important issue is represented by recurrences. Therefore, new therapeutic or strategies already available for treatment of CDI have two goals: eradicating the infection, despite the continuation of concomitant therapy, and reducing the incidence of recurrence. Although metronidazole and vancomycin are and have been the mainstay treatment options for CDI, there are some unmet medical and therapeutical needs (Table 4). Usually oral metronidazole is recommended for initial treatment of non-severe CDI and vancomycin for treatment of severe disease. Fidaxomicin may be considered in patients who cannot tolerate vancomycin, although more data are needed. For treatment of a non-severe initial recurrence of CDI oral metronidazole should be used, but for treatment of subsequent recurrences administering either vancomycin followed by rifaximin, or fidaxomicin may be helpful.