From the Guidelines
Yes, a Urinary Tract Infection (UTI) and Clostridioides difficile (C. diff) infection can be treated simultaneously, but it requires careful consideration of the antibiotics used to avoid exacerbating the C. diff infection.
Treatment Considerations
- When treating a UTI in a patient with C. diff, it is essential to choose antibiotics that are less likely to disrupt the normal gut flora, such as parenteral aminoglycosides, sulfonamides, macrolides, vancomycin, or tetracycline/tigecycline 1.
- For complicated UTIs, the European Association of Urology guidelines recommend using a combination of antibiotics, such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside 1.
- However, it is crucial to avoid using antibiotics that are highly associated with C. diff, such as clindamycin, third-generation cephalosporins, penicillins, and fluoroquinolones, unless absolutely necessary 1.
Key Principles
- Discontinue unnecessary antibiotics to reduce the risk of C. diff recurrence 1.
- Use contact precautions and practice good hand hygiene with soap and water to prevent the transmission of C. diff 1.
- Manage any underlying complicating factors, such as urological abnormalities, to ensure effective treatment of the UTI 1.
From the Research
Treatment of UTI and C. diff Infection
- It is possible to treat Urinary Tract Infection (UTI) and Clostridioides difficile (C. diff) infection simultaneously, but it requires careful consideration of the antibiotics used to avoid exacerbating the C. diff infection 2, 3.
- The use of low-risk antibiotics, such as nitrofurantoin or sulfamethoxazole/trimethoprim, can help reduce the risk of C. diff infection when treating UTI 2.
- Parenteral aminoglycosides, such as gentamicin, can be effective in treating UTI without disrupting the gut microbiota, making them a potential option for patients at high risk of C. diff infection 3.
- Fecal microbiota transplantation (FMT) has been shown to be effective in treating recurrent C. diff infection and may also reduce the frequency of recurrent UTIs by restoring the balance of the gut microbiota 4, 5.
Management of Concomitant Antibiotic Treatment
- When concomitant antibiotic treatment is necessary, it is essential to assess the ongoing requirement for antibiotics and discontinue them when possible 6.
- Changing to a low-risk antibiotic class, such as fidaxomicin, may be preferable to minimize the disruption of the gut microbiome 6.
- Avoiding metronidazole and proton pump inhibitors, and considering the addition of bezlotoxumab, may also be beneficial in managing patients with C. diff infection on concomitant antibiotic treatment 6.