What is the management and treatment of Clostridium difficile (C. difficile) infection with colitis?

From the Guidelines

The management of Clostridium difficile infection with colitis involves prompt antimicrobial therapy based on disease severity, with oral vancomycin 125 mg four times daily for 10 days or fidaxomicin 200 mg twice daily for 10 days recommended as first-line treatment for mild to moderate cases, as stated in the most recent guidelines 1.

Key Considerations

• For severe infections, oral vancomycin 125 mg four times daily for 10 days is preferred.
• In fulminant cases with hypotension, shock, or ileus, the regimen should be escalated to vancomycin 500 mg four times daily by mouth or nasogastric tube, plus intravenous metronidazole 500 mg every 8 hours, with surgical consultation for possible colectomy if clinical deterioration occurs, as recommended by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1.
• Metronidazole 500 mg orally three times daily for 10 days can be considered for mild cases if access to vancomycin or fidaxomicin is limited, though it has lower efficacy.
• Supportive care includes fluid resuscitation, electrolyte replacement, and discontinuation of the inciting antibiotic when possible.
• Probiotics should be avoided during acute infection.
• For recurrent infections, which occur in 15-30% of cases, extended vancomycin pulse-taper regimens or fecal microbiota transplantation may be necessary, with the AGA suggesting the use of conventional fecal microbiota transplant in adults hospitalized with severe or fulminant C difficile infection not responding to antimicrobial therapy 1.

Infection Control Measures

• Contact precautions, hand hygiene with soap and water, and environmental cleaning with sporicidal agents are essential to prevent transmission.
• Patients with CDI should be maintained in contact (enteric) precautions until the resolution of diarrhea (passage of formed stool for at least 48 h).
• Hand hygiene with soap and water and the use of contact precautions along with a good cleaning and disinfection of the environment and patient equipment should be used by all healthcare workers contacting any patient with known or suspected CDI.

From the FDA Drug Label

Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea. Vancomycin Hydrochloride Capsules are also used for the treatment of enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains) in adult and pediatric patients less than 18 years of age DIFICID® is indicated in adult and pediatric patients aged 6 months and older for the treatment of C. difficile-associated diarrhea (CDAD).

The prevalence of Clostridium difficile infection with colitis is not directly addressed in the provided drug labels. However, the management and treatment of Clostridium difficile (C. difficile) infection with colitis can be treated with vancomycin, as it is indicated for the treatment of C. difficile-associated diarrhea and enterocolitis 2. Another option for treatment is fidaxomicin, which is indicated for the treatment of C. difficile-associated diarrhea (CDAD) 3. Key points to consider when treating C. difficile infection with colitis include:

• Using vancomycin or fidaxomicin as indicated for the treatment of C. difficile-associated diarrhea and enterocolitis
• Monitoring for potential adverse reactions, such as nephrotoxicity and ototoxicity, especially in patients over 65 years of age
• Discontinuing treatment at the first appearance of signs and symptoms of severe dermatologic reactions.

From the Research

Management and Treatment of Clostridium difficile Infection with Colitis

The management and treatment of Clostridium difficile (C. difficile) infection with colitis involve several approaches, including:

• Antibiotic therapy: Vancomycin and fidaxomicin are recommended as first-line therapy for most cases of CDI 4, 5, 6, 7.
• Fecal microbiota transplantation: This is an effective and safe treatment for recurrent CDI 4, 5, 6, 7.
• Bezlotoxumab: A monoclonal antibody that can be used to prevent recurrences of CDI 5, 6.
• Metronidazole: Although metronidazole is no longer recommended as primary therapy for CDI, it may still be used in mild-to-moderate disease in younger patients with no or few risk factors for recurrence 6.

Treatment Guidelines

Current treatment guidelines for CDI recommend:

• Vancomycin or fidaxomicin as first-line therapy for most cases of CDI 4, 5, 6, 7.
• Fecal microbiota transplantation for patients with frequently recurring CDI 5, 6, 7.
• Bezlotoxumab as an adjunctive therapeutic strategy for patients with several risk factors for recurrence 5, 6.

Prevention of Recurrent CDI

Prevention of recurrent CDI is crucial, and several strategies can be employed, including:

• Antibiotic stewardship: Judicious use of antimicrobial agents can help prevent CDI 4, 5, 7, 8.
• Infection control measures: Implementation of infection-control measures can help prevent the spread of C. difficile 4, 5, 7, 8.
• Fecal microbiota transplantation: This can be used to prevent recurrent CDI in patients who have had multiple recurrences 5, 6, 7.
• Bezlotoxumab: This can be used to prevent recurrences of CDI in patients with several risk factors for recurrence 5, 6.