From the Guidelines
Clostridium difficile (C. diff) infection typically does not resolve on its own and requires treatment with antibiotics. While mild cases occasionally clear without medication, most infections will persist or worsen without proper treatment. The standard treatment for C. diff includes antibiotics such as vancomycin (125 mg orally four times daily for 10 days) or fidaxomicin (200 mg twice daily for 10 days) for less severe cases, as recommended by the 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients 1.
During treatment, it's essential to stay hydrated, avoid anti-diarrheal medications which can worsen the condition, and practice strict hand hygiene to prevent spreading the infection. C. diff produces toxins that damage the intestinal lining, causing inflammation and diarrhea, and without treatment to eliminate these bacteria, the toxins continue to cause damage. Approximately 20% of patients experience recurrence after initial treatment, which may require extended antibiotic courses or other interventions like fecal microbiota transplantation in severe recurrent cases, as suggested by the clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1.
Some key points to consider in the treatment of C. diff include:
- The use of vancomycin or fidaxomicin as the initial treatment for C. diff, with vancomycin being administered using a prolonged tapered and/or pulsed regimen for recurrent cases 1
- The potential for cumulative neurotoxicity with metronidazole, making it less suitable for long-term therapy 1
- The importance of proper hand hygiene and infection control measures to prevent the spread of C. diff 1
- The potential benefits of fecal microbiota transplantation (FMT) in patients with multiple recurrences of C. diff who have failed to resolve their infection despite treatment attempts with antibiotic agents targeting C. diff, as demonstrated by a randomized trial of FMT which showed symptom resolution in 94% of patients who received vancomycin for 5 days followed by either one or two treatments with FMT, versus 31% in those receiving vancomycin alone for 14 days 1.
Overall, prompt medical attention is necessary if C. diff infection is suspected, rather than waiting for it to resolve on its own.
From the Research
Resolution of C. Diff Infection
- C. difficile infection can resolve on its own in some cases, as it causes no symptoms in more than one-half of infected patients 2.
- However, the infection can also cause a wide spectrum of illnesses and death, especially in older adults, hospitalized patients, and those with multiple comorbidities 2, 3.
Treatment of C. Diff Infection
- Discontinuing the contributing antibiotic, if possible, is the first step in treating C. difficile infection 2.
- Mild C. difficile infection can be treated with oral metronidazole, while severe infection requires oral vancomycin 2.
- Fidaxomicin may be an effective alternative for treating C. difficile infection, especially in patients at risk of relapse 3, 4.
- For recurrent C. difficile infection, vancomycin combined with fecal microbiota transplantation is a recommended treatment option 4, 5.
Effectiveness of Treatment Options
- Fecal microbiota transplantation (FMT) has been shown to be superior to fidaxomicin and vancomycin in treating recurrent C. difficile infection, with a higher rate of clinical resolution and negative test results for C. difficile toxin 5.
- Fidaxomicin can be an effective treatment option for C. difficile infection in patients with inflammatory bowel disease, with a response rate of 60.6% in one study 6.
- However, patients who do not respond to fidaxomicin may require alternative treatments, such as fecal microbiota transplantation 6.