From the Guidelines
Patient education for active C. difficile diarrhea should prioritize infection control measures, including hand hygiene with soap and water, as alcohol-based sanitizers are not effective against C. difficile spores. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, hand hygiene should be performed after using the toilet, changing diapers, before and after preparing food, before eating, after handling garbage or soiled laundry items, and after touching animals or their feces or environments.
Key Education Points
- Patients should wash hands thoroughly with soap and water after using the bathroom and before eating
- Use separate bathroom facilities if possible
- Household surfaces should be cleaned with bleach-based products (1:10 dilution) as recommended 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
- Medication adherence is crucial, with patients completing the full course of prescribed antibiotics
- Maintain hydration by drinking plenty of fluids and temporarily avoid dairy products, spicy foods, and high-fiber foods that may worsen diarrhea
- Monitor for warning signs requiring immediate medical attention: severe abdominal pain, fever above 101°F, bloody stools, signs of dehydration, or worsening symptoms despite treatment
Additional Considerations
- Patients should be aware of the risk of recurrence, which occurs in 15-30% of cases, and report any return of symptoms promptly, even weeks after treatment completion
- Healthcare providers should direct educational efforts toward all people with diarrhea, but particularly to people with primary and secondary immune deficiencies, pregnant women, parents of young children, and the elderly as they have increased risk of complications from diarrheal disease 1
- Ill people with diarrhea should avoid swimming, water-related activities, and sexual contact with other people when symptomatic while adhering to meticulous hand hygiene 1
From the Research
Treatment Options for C-Diff Diarrhea
- The cornerstones for the treatment of CDI are vancomycin and fidaxomicin 2
- Metronidazole should be used only in mild-to-moderate disease in younger patients who have no or only few risk factors for recurrence 2
- Bezlotoxumab infusion may be considered as an adjunctive therapeutic strategy in addition to the standard care provided to patients with several risk factors for recurrence 2, 3
- Faecal microbiota transplantation (FMT) should be offered to patients with frequently recurring CDI 2, 4, 5
Prevention of Recurrent C-Diff Infection
- Fidaxomicin and FMT administered by nasogastric tube have demonstrated efficacy in preventing rCDI 5
- Actoxumab plus bezlotoxumab in combination or bezlotoxumab alone appeared to be more effective in preventing rCDI compared to actoxumab alone 5
- Oligofructose, Saccharomyces boulardii, and the nontoxigenic C. difficile strain M3 were found to be efficacious for rCDI prevention 5
- Bezlotoxumab reduced rCDI, fecal microbiota transplants, and CDI-associated 30-day readmissions in participants with risk factors for rCDI 3
Patient Education for Active C-Diff Diarrhea
- Patients with CDI should be educated on the importance of completing the full treatment course and the potential for recurrence 2, 6
- Patients at high risk for recurrence, such as those with compromised immunity or history of CDI, should be educated on the available prevention options, including bezlotoxumab and FMT 4, 3