From the Guidelines
It is not recommended to treat Clostridioides difficile (C. diff) infection without proper diagnostic testing. Diagnosis should be confirmed through stool tests before starting treatment because the symptoms of C. diff (diarrhea, abdominal pain, fever) can mimic other gastrointestinal conditions. Treatment without testing could lead to inappropriate antibiotic use, which might worsen the condition or contribute to antibiotic resistance.
Key Considerations
- Diagnostic testing for CDI should be performed only in symptomatic patients 1
- Testing of formed stool can result in false positive tests, which may result in unnecessary antibiotic therapy 1
- Nucleic acid amplification tests (NAAT) for C. difficile toxin genes appear to be sensitive and specific and may be used as a standard diagnostic test for CDI 1
Diagnostic Approach
- If C. diff is suspected, healthcare providers typically order tests like enzyme immunoassay (EIA) for C. diff toxins or PCR testing to detect the bacteria 1
- Clinical context such as a history of recent antibiotic administration and/or residence in hospital are useful in selecting patients for testing 1
Treatment
- Once confirmed, standard treatments include oral vancomycin (125 mg four times daily for 10-14 days), fidaxomicin (200 mg twice daily for 10 days), or in milder cases, metronidazole (500 mg three times daily for 10-14 days) 1
- Any antibiotics that may have triggered the C. diff infection should be discontinued if possible 1
Infection Control
- Treating without testing is particularly risky because C. diff is highly contagious and requires specific infection control measures, and misdiagnosis could delay appropriate treatment for the actual condition causing symptoms 1
From the Research
Treatment of Clostridioides difficile Infection
- The treatment of Clostridioides difficile infection (CDI) typically involves the use of antibiotics such as vancomycin, metronidazole, or fidaxomicin 2, 3, 4.
- Fecal microbiota transplantation (FMT) has emerged as a promising therapy for recurrent CDI, with success rates of over 85% compared to less than 50% with antibiotics for multiple recurrent CDI 5, 6.
- The choice of treatment may depend on the severity of the infection, the presence of recurrent episodes, and the patient's overall health status.
Diagnostic Testing
- While diagnostic testing is typically used to confirm the presence of C. difficile infection, it may not always be necessary to treat the infection 2, 4.
- In some cases, treatment may be initiated based on clinical symptoms and medical history, particularly in patients with a history of recurrent CDI or those who have not responded to previous treatments.
Effectiveness of Different Therapies
- A systematic review and network meta-analysis of randomized controlled trials found that FMT was the most effective treatment for CDI in terms of cure rate, particularly in recurrent cases 6.
- Fidaxomicin and ridinilazole were also found to be effective in preventing recurrence, while probiotics were not effective in preventing CDI 6.
- The study highlights the potential for increased use of FMT in clinical settings, but further research is needed to optimize FMT protocols and explore its long-term safety and efficacy.