How to Treat Clostridium difficile Infections in 2014?

Abstract

During the last decade, Clostridium difficile emerged as a major enteropathogen, mainly because the infections became more frequent, more severe, and more refractory to standard treatments. In order to take into account recent therapeutic advances in the clinical management of patients with C. difficile infections (CDI), the European guidelines have been updated in 2013. Oral metronidazole (500 mg × 3/d, 10 d) is still the drug of choice for the initial episode ofmild tomoderate CDI. Vancomycin (125mg × 4/d, 10 d) is proposed in case of severe CDI, but fidaxomicin (200 mg × 2/d, 10 d) can be used as an alternative. Colectomy should be early considered in case of severely ill patients (megacolon or septic shock). Treatment of the first recurrence or patients at high risk of recurrence is based on the use of vancomycin (125 mg × 4/d, 10 d) or fidaxomicin (200 mg × 2/d, 10 d). Fecal transplantation has become the best treatment of multiple recurrences (A-I) but the use of fidaxomicin or tapered and pulse dose of vancomycin are two other possible options (B-II).