Materiały źródłowe

• #1 Management of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5114503/

  Since the discovery of Clostridium difficile infection (CDI) in the 1970s, there has been an increase in the incidence, severity, and recurrence rate of the disease. […] Recommended therapy for CDI includes oral metronidazole for mild cases and oral vancomycin or fidaxomicin for moderate to severe cases, each given for 10 to 14 days. […] Treatment with metronidazole has been associated with an increasing failure rate, and the only clear recommended form of metronidazole for treatment of CDI is the intravenous formulation for patients unable to take oral medications. […] For vancomycin or fidaxomicin treatment of first CDI recurrences, the drug used in the initial bout can be repeated. […] New modalities of treatment, such as bacteriotherapy and immunotherapy, show promise for the treatment of recurrent CDI.

• #1 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  The decision to treat C difficile infection (CDI) and the type of therapy administered depend on the severity of infection, as well as the local epidemiology and type of C difficile strains present. Except for perioperative prophylaxis, it is recommended that the use of cephalosporin and clindamycin be restricted for infection prevention. No treatment is necessary for asymptomatic carriers. […] For symptomatic patients, the Infectious Diseases Society of America (ISDA) and Society for Healthcare Epidemiology of America (SHEA) 2021 updated guideline for CDI treatment recommend administering fidaxomicin for initial and recurrent infections, with oral vancomycin as an alternative. Fecal microbiota transplantation (FMT) may also be added after treating the second recurrence. Bezlotoxumab had been recommended as adjunctive treatment for recurrent CDI, but it has been discontinued as of January 31, 2025.

• #2 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  The decision to treat C difficile infection (CDI) and the type of therapy administered depend on the severity of infection, as well as the local epidemiology and type of C difficile strains present. Except for perioperative prophylaxis, it is recommended that the use of cephalosporin and clindamycin be restricted for infection prevention. No treatment is necessary for asymptomatic carriers. […] For symptomatic patients, the Infectious Diseases Society of America (ISDA) and Society for Healthcare Epidemiology of America (SHEA) 2021 updated guideline for CDI treatment recommend administering fidaxomicin for initial and recurrent infections, with oral vancomycin as an alternative. Fecal microbiota transplantation (FMT) may also be added after treating the second recurrence. Bezlotoxumab had been recommended as adjunctive treatment for recurrent CDI, but it has been discontinued as of January 31, 2025.

• #3 C. difficile infection – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/drc-20351697

  Treatments are used only for symptoms of infection. People who carry the bacteria but aren’t sick don’t get treated. […] Antibiotics are the main treatment for C. difficile infection. Commonly used antibiotics include: Vancomycin (Firvanq Kit), Fidaxomicin (Dificid). […] Metronidazole (Flagyl) may be used with vancomycin to treat serious C. difficile infection. […] Surgery to remove the diseased part of the colon may be needed if there’s: Severe pain, Organ failure, Toxic megacolon, Swelling and irritation, called inflammation, of the lining of the wall around the stomach area. […] Treatment for C. difficile infection that comes back might include the following: Antibiotics. Treatment for repeat infections may involve one or more courses of an antibiotic. The antibiotic is often different from the one used at first. Antibiotic therapy works less well each time the infection comes back.

• #4 Clostridioides difficile infection – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/clostridioides-difficile-infection/

  Antibiotic treatment is indicated in all symptomatic patients with CDI and should be guided by the severity of CDI. […] Asymptomatic carriers do not require antibiotic therapy. […] Fecal microbiota transplantation may be indicated in recurrent CDI, severe CDI, or fulminant CDI refractory to antibiotic therapy. […] Surgical intervention may be necessary for critically ill patients or those with complications necessitating surgery. […] Antibiotic therapy for C. difficile infection in adults includes oral fidaxomicin or oral vancomycin for nonsevere or severe CDI. […] For fulminant CDI, high-dose oral vancomycin is the first-line treatment, and IV metronidazole may be considered. […] In patients with paralytic ileus, consider adding vancomycin enemas. […] For recurrent CDI, oral fidaxomicin or tapered and pulsed oral vancomycin are recommended.

• #5 Medication for Clostridium Difficile Infections | NYU Langone Health

  https://nyulangone.org/conditions/clostridium-difficile-infections/treatments/medication-for-clostridium-difficile-infections

  If you are taking antibiotics and have an infection with Clostridium difficile, your NYU Langone doctor discontinues the medication that triggered the infection, if possible. […] If discontinuing the antibiotics does not alleviate your symptoms, your doctor recommends another antibiotic to eliminate the original infection, as well as the diarrhea. Commonly prescribed medications include metronidazole, vancomycin, and fidaxomicin. […] For people with a mild-to-moderate C. difficile infection, a doctor may prescribe metronidazole. Those with persistent symptoms or a recurrent C. difficile infection may be given vancomycin. […] If a C. difficile infection returns after treatment, the infection is usually treated with the same antibiotic used the first time. If the infection recurs a second time, doctors prescribe either vancomycin or fidaxomicin. […] Antibiotics are typically taken by mouth for around 14 days. Most people notice an improvement in symptoms within three to four days. It is important to continue taking the medication until you finish it. Otherwise, it may not kill all of the C. difficile bacteria and may lead to a recurrence.

• #6 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. […] The guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management. […] Discontinue therapy with the inciting antibiotic agent(s) as soon as possible, as this may influence the risk of CDI recurrence (strong recommendation, moderate quality of evidence). […] Antibiotic therapy for CDI should be started empirically for situations where a substantial delay in laboratory confirmation is expected, or for fulminant CDI (described in section XXX) (weak recommendation, low quality of evidence).

• #7 Recommendations | Clostridioides difficile infection: antimicrobial prescribing | Guidance | NICE

  https://www.nice.org.uk/guidance/ng199/chapter/Recommendations

  The recommendations in this guideline update existing Public Health England guidance on treating Clostridioides difficile infection. […] For adults, offer an oral antibiotic to treat suspected or confirmed C. difficile infection (see the recommendations on choice of antibiotic). In the community, consider seeking prompt specialist advice from a microbiologist or infectious diseases specialist before starting treatment. […] For children and young people under 18 years, offer an oral antibiotic to treat suspected or confirmed C. difficile infection. Treatment should be started by, or after advice from, a microbiologist, paediatric infectious diseases specialist or paediatric gastroenterologist. […] For people with suspected or confirmed C. difficile infection who cannot take oral medicines, seek specialist advice from a gastroenterologist or pharmacist about alternative enteral routes for antibiotics, such as a nasogastric tube or rectal catheter.

• #8 C. diff Infection: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15548-c-diff-infection

  Clostridioides difficile, or C. diff, is a highly contagious bacterium that causes diarrhea and colitis. […] You have to take a different antibiotic to treat C. diff. […] Treatment for C. diff infection is based on how severe it is. If you developed a C. diff infection while taking antibiotics, your provider might begin by simply stopping those medications. […] If this doesn’t happen, your provider will prescribe antibiotics that can stop C. diff. […] Antibiotics to treat C. diff include: Metronidazole, Vancomycin, Fidaxomicin. […] If you have a mild infection, you’ll take the prescription home with you. Most people will start improving in a few days. If your infection is more severe, you might need to stay in the hospital. […] In the hospital, your provider might give you antibiotics through an IV, along with fluids to prevent dehydration. In some cases, they might deliver medications directly into your colon as an enema.

• #9 Management of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5114503/

  For the treatment of a second recurrence of CDI, a repeat 10-day course of vancomycin followed by 6 to 7 weeks of tapering or a pulse strategy is recommended to inhibit the vegetative cells of C difficile while allowing restoration of the intestinal microbiota. […] Fecal microbiota transplantation (FMT) is considered the most effective therapeutic approach to treat patients with at least 3 recurrences of CDI. […] Cure rates exceed 90% following FMT for multiple-recurrent CDI. […] FMT is a cost-effective strategy for the treatment of multiple-recurrent CDI if available, and it is less expensive and more effective than a prolonged course of vancomycin. […] Another approach to the treatment of recurrent CDI is to facilitate immune responsiveness to the toxins of C difficile. […] Intravenous immunoglobulin (IVIG) is another option that can be considered in the treatment of recurrent CDI. […] Further studies are needed to establish an accurate test to diagnose CDI to prevent treating patients colonized by C difficile who have diarrhea due to another cause.

• #10 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  In patients with severe, complicated, or fulminant CDI (hypotension, shock, ileus or megacolon), oral (or via nasogastric tube) vancomycin 500 mg every 6 hours along with intravenous (IV) metronidazole is recommended. Rectal vancomycin may also be added in patients with ileus. […] Treatment recommendations for CDI have evolved over the past few years. One reason for change is the frequent relapse rate of CDI (20-27%). In 2021, the ISDA recommended using fidaxomicin first line for treatment of an initial CDI episode as well as subsequent recurrence. Relative to vancomycin, fidaxomicin is not only a more targeted intestinal antibiotic but also associated with fewer CDI recurrences. Vancomycin is still considered to be an acceptable alternative. However, metronidazole is no longer recommended unless fidaxomicin and vancomycin are not available.

• #11 Clinical Practice Guidelines for the Management of Clostridioides difficile Infection in Adults: 2021 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridioides-difficile-2021-focused-update/

  This clinical practice guideline is a focused update on management of Clostridioides difficile infection (CDI) in adults specifically addressing the use of fidaxomicin and bezlotoxumab for the treatment of CDI. […] For patients with an initial CDI episode, we suggest using fidaxomicin rather than a standard course of vancomycin (conditional recommendation, moderate certainty of evidence). […] In patients with recurrent CDI episodes, we suggest fidaxomicin (standard or extended-pulsed regimen) rather than a standard course of vancomycin (conditional recommendation, low certainty evidence). […] For patients with a recurrent CDI episode within the last 6 months, we suggest using bezlotoxumab as a co-intervention along with SOC antibiotics rather than SOC antibiotics alone (conditional recommendation, very low certainty of evidence).

• #12 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  Initial treatment: Treatment with fidaxomicin 200 mg by mouth twice a day for 10 days. If fidaxomicin is not available, then use oral vancomycin 125 mg by mouth four times a day for 10 days as an alternative. In nonsevere CDI (white blood cell [WBC] count 15,000 cells/uL and creatinine level 1.5 mg/dL), if fidaxomicin and vancomycin are not available, then use metronidazole 500 mg every 8 hours for 10-14 days. […] Fulminant (hypotension or shock, ileus, or megacolon) CDI: Vancomycin 500 mg every 6 hours by mouth or nasogastric tube, combined with IV metronidazole 500 mg every 8 hours. In patients with ileus, consider adding rectal vancomycin 500 mg every 6 hours in 100 mL normal saline as a retention enema. […] In a multicenter retrospective (2013-2014) study of CDI in 72 Spanish patients, fidaxomicin treatment was effective and well tolerated in patients with severe CDI as well as those at high risk of recurrent disease. The clinical cure rate was 90.3%, with a 16.7% recurrence and a 72.2% sustained cure.

• #13 Clinical Practice Guidelines for the Management of Clostridioides difficile Infection in Adults: 2021 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridioides-difficile-2021-focused-update/

  Fidaxomicin, approved by the FDA in May 2011, was the first new drug approved for CDI treatment in 31 years. […] The panel suggests the use of fidaxomicin as the preferred therapy for an initial CDI episode to improve sustained response after therapy but recognizes that vancomycin remains an acceptable alternative if fidaxomicin is not available. […] The panel suggests the use of fidaxomicin as the preferred therapy for patients with recurrent CDI episode(s) to improve sustained response after therapy. […] The panel agrees that the overall balance of benefits and harms favors using fidaxomicin rather than vancomycin for patients with CDI recurrence and that the certainty of evidence was low. […] The panel agrees that the overall balance of benefits and harms favors adding bezlotoxumab to SOC antibiotics for patients with a CDI episode and at least 1 risk factor for recurrence.

• #14 Management of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5114503/

  Guidelines for the treatment of CDI provided by the Infectious Diseases Society of America in 2010 recommended that oral metronidazole be used for all but the more severe cases of CDI, where oral vancomycin would be preferred. […] Vancomycin or fidaxomicin (Dificid, Merck) is a better choice for all clinically important cases of CDI because of metronidazole’s flawed pharmacokinetics for intestinal infections. […] The recommended oral dose of vancomycin is 125 mg 4 times daily for 10 to 14 days. […] In 2011, fidaxomicin was approved by the US Food and Drug Administration for the treatment of CDI. […] Fidaxomicin given in a dose of 200 mg twice daily for 10 days is associated with a lower rate of recurrence compared with a 10-day course of oral vancomycin (125 mg 4 times daily) for CDI caused by non-NAP1/ribotype 027 strains.

• #15 Biliary Tract Disorders, Gallbladder Disorders, & Gallstone Pancreatitis | ACG

  https://gi.org/topics/c-difficile-infection/

  C. Difficile Infection (CDI) Overview […] Treatment for C. difficile is based on the severity of the infection. The current guidelines separate C. difficile infection into 3 categories: non-severe, severe and fulminant. Non-severe infections are usually treated in the outpatient setting. The standard of care treatment is vancomycin 125mg, four times a day for ten days or fidaxomicin 200mg, twice a day for ten days. The vast majority of patients will have resolution of symptoms after appropriate treatment. If diarrhea does not improve with appropriate antibiotics, an alternative diagnosis for diarrhea should be considered. Antidiarrheal drugs are not recommended to treat C. difficile infection and should only be used in consultation with your physician. […] Severe infections are diagnosed based on laboratory data including elevated white blood cell count (>15,000) and worsening kidney function (Creatinine >1.5). These patients are typically very sick with fever, abdominal pain, tenderness and dehydration and are often hospitalized. Similar to non-severe infections, patients with severe C. difficile infection should be treated with vancomycin 125mg, four times per day for 10 days or fidaxomicin 200mg, twice a day for ten days.

• #16 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Guidelines for the diagnosis and treatment of Clostridioides difficile infection have recently been updated. Treatment depends on whether the episode is an initial vs. recurrent infection and on the severity of the infection based on white blood cell count, serum creatinine level, and other clinical signs and symptoms. For an initial episode of nonsevere C. difficile infection, oral vancomycin or oral fidaxomicin is recommended. Metronidazole is no longer recommended as first-line therapy for adults. Fecal microbiota transplantation is a reasonable treatment option with high cure rates in patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes. […] Oral vancomycin and fidaxomicin (Dificid) are preferred over metronidazole for initial episodes of C. difficile infection.

• #17 Effective treatment of Clostridioides difficile infection improves survival and affects graft-versus-host disease: a multicenter study by the Polish Adult Leukemia Group | Scientific Reports

  https://www.nature.com/articles/s41598-024-56336-3

  Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea after allogeneic hematopoietic cell transplantation (allo-HCT). […] The first-line treatment for CDI included metronidazole in 34 patients, vancomycin in 64, and combination therapy in 10. Treatment failure was more common with metronidazole than vancomycin (38.2% vs. 6.2%; P0.001). […] Therefore, agents with higher efficacy than metronidazole (vancomycin or fidaxomicin) should be administered as the first-line treatment. […] The current study shows that vancomycin is superior to metronidazole as the first-line treatment of CDI in patients after allo-HCT. The administration of metronidazole was associated with a higher rate of treatment failure and worse OS, as compared with vancomycin.

• #18 C diff (Clostridium difficile) Infection – familydoctor.org

  https://familydoctor.org/condition/clostridium-difficile-c-diff-infection/

  If you were taking an antibiotic when your symptoms started, your doctor will probably ask you to stop taking it. They will watch you for dehydration if you have severe diarrhea. About 25% of patients begin to improve 2 to 3 days after they stop the antibiotic that caused the infection. […] For severe cases, your doctor may prescribe a 10-day dose of an antibiotic that has proved effective in treating C. diff. infections. Examples include metronidazole and vancomycin. You should improve after 72 hours of starting the medicine, although the diarrhea may continue. In about 15% to 35% of cases, a second round of antibiotics is needed. […] While you recover, drink plenty of fluids to replace what your body lost due to diarrhea. Avoid milk products and foods that contain wheat flour or are high in fiber. Your digestive tract may be sensitive to them for a few days.

• #19 Current Treatment Options for Severe Clostridium difficile–associated Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3088840/

  The two most common drugs used to treat C. difficile are metronidazole (500 mg PO TID) and vancomycin (125 mg PO QID) for 10-14 days. The standard first-line therapy in both the inpatient and outpatient settings remains oral metronidazole, unless there are contraindications to the medicine such as first trimester of pregnancy or inability to tolerate it. For severe disease, initial therapy with vancomycin is now recommended. In all patients with CDAD, inciting antibiotics should be discontinued, if possible, or changed to a regimen with a narrower spectrum. Antimotility agents should not be used, even in mild cases. […] Of patients with C. difficile infection, 38% develop fulminant colitis. Markers of disease severity include ileus, renal insufficiency, colon wall thickening on computed tomography imaging, and endoscopic visualization of pseudomembranes, as well as the usual signs of septic physiology: fever, significant leukocytosis, hypotension requiring fluid resuscitation, and tachypnea. These markers may portend toxic megacolon, imminent intestinal perforation, or fulminant colitis, and they may predict a significantly higher risk of colectomy or death. Empiric therapy should be started for ill patients as soon as C. difficile is suspected, to avoid any delay related to obtaining the results of stool or equivocal examinations.

• #20 Biliary Tract Disorders, Gallbladder Disorders, & Gallstone Pancreatitis | ACG

  https://gi.org/topics/c-difficile-infection/

  Fulminant infections are defined by the presence of shock, low blood pressure, or toxic megacolon. Toxic megacolon is where the large intestine is dilated and at risk of perforating. These patients are at high risk of dying from their infection. Treatment includes higher doses of vancomycin 500mg four times per day. These patients often require intensive care monitoring and consultation with a surgeon as surgery to remove the colon may be needed to save the person’s life. […] Current recommendations for the treatment of recurrent CDI include a vancomycin taper over six to eight weeks or fidaxomicin for ten days. Bezlotuxumab is a recently approved drug to prevent recurrent infections and is given as a one-time IV infusion during a course of antibiotics for CDI. The most effective treatment, however, is fecal microbiota transplant (FMT). FMT is typically administered via colonoscopy where stool from a healthy donor is instilled into the colon of a patient with recurrent CDI. In studies, it has been effective in over 90% of patients who received the treatment, and has been proven effective with several randomized controlled trials. There are ongoing clinical trials using oral encapsulated forms of FMT, which are the future of this “drug.”

• #21 Current Treatment Options for Severe Clostridium difficile–associated Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3088840/

  Importantly, oral metronidazole monotherapy is not an appropriate initial treatment for patients at highest risk, in particular, those who present with significant predictors of disease severity or are of advanced age and have worrisome comorbidities. […] Thus, vancomycin is now recommended for initial therapy of severe disease. Although the standard regimen for vancomycin is 125 mg orally four times daily, in our experience, some severely ill patients require higher doses of 250 mg or even 500 mg orally four times daily. […] In such ill patients, adjunct therapies such as intravenous (IV) metronidazole may be helpful. […] Another adjunctive therapy is the rectal administration of vancomycin. […] In the fall of 2007, Cohen presented new Infectious Diseases Society of America guidelines, soon to be published, for treatment of severe and complicated CDAD. Severe CDAD is defined as patients having a white blood cell count greater than 15,000 cells/L and/or a 50% rise in serum creatinine. In these patients, the guidelines recommend initial therapy with vancomycin 125 mg four times daily. Complicated CDAD is defined as the presence of one or more of the following factors: hypotension, ileus, toxic megacolon, need for ICU admission or colectomy, or colonic perforation. In these patients, if complete ileus is not present, the guidelines recommend vancomycin 500 mg four times a day orally or per nasogastric tube and/or IV metronidazole 500-750 mg every 8 hours. For patients with a complete ileus, the recommendations include IV metronidazole and rectal vancomycin (500 mg in 100 mL of normal saline every 6 hours via rectal Foley tube).

• #22 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  In fulminant cases, combined therapy with IV metronidazole and vancomycin (PO or PR) is the treatment of choice. IV vancomycin is ineffective and should not be used for C difficile. […] FMT is a novel therapy that involves the transfer of stool from a healthy donor to a patient with CDI to reconstitute the normal colonic microbial flora. It is given after treating CDI with antibiotics. Studies have evaluated prevention of recurrence of CDI after FMT. Several studies have shown that FMT by colonoscopy or enema was an effective approach for patients with recurrent CDI, with clinical success rates of up to 95%. […] In November 2022, the FDA approved microbiota via rectal administration (Rebyota) for prevention of recurrence of CDI in adults following antibiotic treatment for CD recurrence. Approval was based on the PUNCH CD3 phase 3 clinical trial.

• #23 Clostridioides difficile infection – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/clostridioides-difficile-infection/

  C. difficile infection is one of the rare indications for PO vancomycin in adults and children. […] Intravenous administration of vancomycin is ineffective for C. difficile infection because vancomycin is insufficiently excreted into the colon. […] Consider bezlotoxumab, a monoclonal antibody against the C. difficile toxin B, in adults at risk of recurrent CDI. […] Fecal microbiota transplantation (FMT) can be considered in severe CDI or fulminant CDI with insufficient clinical improvement after 48-72 hours of maximum medical therapy. […] Surgical management may be indicated for critically ill patients with severe CDI or fulminant CDI refractory to antibiotic therapy.

• #24 C. difficile infection – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/drc-20351697

  Antibody-based therapy. A therapy known as bezlotoxumab (Zinplava) is a human antibody against C. difficile toxin B. It has been shown to cut the risk of repeat C. difficile infection in those at high risk of repeat episodes. […] Fecal microbiota transplant (FMT). FMT is a newer treatment for C. difficile infection that keeps coming back. FMT has been studied in clinical trials. The U.S. Food and Drug Administration has not approved FMT but allows the use of FMT for C. difficile infection as a test. […] Research has shown that FMT done one or more times has a success rate higher than 85% for treating C. difficile infections that keep coming back. […] Probiotics are supplements or foods that have microorganisms to keep or improve the „good” bacteria in the body. The role of these products in C. difficile infection is not clear. Not all the research has shown that probiotics are helpful in preventing or treating infection with C. difficile.

• #25 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  Once infected with C difficile, the rate of disease recurrence is 20-40% when using metronidazole and vancomycin antibiotics as first-line therapy. […] Fidaxomicin is now recommended as first-line treatment due to a lower risk of CDI recurrence. […] In patients with CDI who develop fulminant colitis, early surgical consultation is crucial. […] The use of oral metronidazole or vancomycin produces response rates of greater than 95% in mild to moderate cases, with symptomatic improvement (diarrhea) in as little as 3-4 days and complete resolution in 7-10 days. […] Yet approximately 20-27% of patients treated for a first episode of C difficile colitis relapse after successfully completing therapy, typically 3 days to 3 weeks after treatment has ended. […] Patients who relapse once are at an even greater risk for further relapses; the relapse rate for patients with 2 or more relapses is 65%.

• #26 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Fecal microbiota transplantation is recommended for patients with multiple recurrences of C. difficile infection in whom appropriate antibiotic therapy has been ineffective. […] The 2017 IDSA guidelines recommend oral vancomycin or fidaxomicin (Dificid) for treatment of nonsevere initial C. difficile infection. Multiple randomized, placebo-controlled trials have shown that oral vancomycin is superior to metronidazole, which is no longer recommended as a first-line treatment for initial episodes of C. difficile infection. […] Treatment options for the first recurrence include vancomycin if metronidazole was used for the initial episode, or if a standard vancomycin regimen was used for the initial episode, either fidaxomicin or a prolonged vancomycin taper followed by pulsed vancomycin. […] There are several treatment options for patients who have had multiple recurrent episodes of C. difficile infection and have received appropriate antibiotic therapy for at least three episodes. Vancomycin can be given, either in a tapered and pulsed regimen or four times per day for 10 days followed by rifaximin (Xifaxan) three times per day for 20 days. Alternatively, fidaxomicin can be used twice per day for 10 days. Fecal microbiota transplantation is also a reasonable option.

• #27 Recurrent Clostridioides difficile infection: Recognition, management, prevention | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/6/347

  Clostridioides difficile infection (CDI) is the most common cause of diarrhea in hospitalized patients and results in substantial morbidity, mortality, and costs. Its clinical management, primarily with antibiotics, is often complicated by recurrent episodes. […] The goal of therapy for recurrent CDI is to allow the normal colonic microbiota to restore itself. […] Fecal microbiota transplantation has shown efficacy for treating recurrent CDI. […] Treatment of recurrent CDI, according to the IDSA and SHEA guidelines, is based on the episode number of CDI, with nonsevere disease and severe disease being treated similarly. […] A first recurrence (ie, a second episode), whether severe or nonsevere, has 3 options: Vancomycin, 125 mg orally 4 times a day for 10 days (if metronidazole was used for the initial episode); Vancomycin in a tapered and pulsed regimen (rather than a second standard 10-day vancomycin course), such as 125 mg orally 4 times per day for 10 to 14 days, then twice a day for 7 days, then once a day for 7 days, then every 2 or 3 days for 2 to 8 weeks; Fidaxomicin 200 mg orally 2 times per day for 10 days (if vancomycin was used for the initial episode).

• #28 Recurrent Clostridioides difficile infection: Recognition, management, prevention | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/6/347

  A second recurrence, whether severe or nonsevere, has 4 options: Vancomycin in a tapered and pulsed regimen; Vancomycin 125 mg 4 times a day by mouth for 10 days followed by rifaximin for 20 days; Fidaxomicin 200 mg orally 2 times a day for 10 days; Fecal microbiota transplantation. […] Fecal microbiota transplantation is associated with resolution of recurrent CDI, but its role in initial CDI episodes and fulminant CDI is not established.

• #29 C. diff Infection: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15548-c-diff-infection

  If you have severe complications, you might need intensive care. In rare cases, providers recommend emergency surgery to remove the source of the infection in your colon. This is called colectomy. […] If you’ve recovered but you continue to have repeat infections after treatment, your options are: Repeat antibiotic therapy. Your provider may give you a different drug, or a longer prescription for the same drug. After antibiotics, your provider may recommend that you take probiotics to help restore your gut bacteria. […] Fecal microbiota transplant. When repeat antibiotic therapy fails, fecal transplantation has proved highly effective in preventing recurrent C. diff infection. Fecal transplantation involves transferring a poop sample from a healthy donor into a diseased colon. The sample will restore balance to your gut microbiome.

• #30 Clostridioides difficile (C. diff) – AGA GI Patient Center

  https://patient-staging.gastro.org/clostridioides-difficile-c-diff/

  Fecal microbiota transplant: This can be given either orally, as a pill, through a colonoscopy or through an enema after you finish your antibiotics for C. diff. This treatment improves the number of different organisms in your large bowel, making the bowel healthier, which then helps get rid of this infection. […] Rarely, in very severe, life-threatening cases, it may be necessary to remove the infected part of the intestine.

• #31 Breaking the cycle: New treatments for recurrent C diff offer an alternative to repeated antibiotics | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/breaking-cycle-new-treatments-recurrent-c-diff-offer-alternative-repeated

  Both Rebyota and Vowst are based on the principle established by FMT, which aims not to treat rCDI but to restore the health of the patient’s microbiome following antibiotic therapy in order to prevent more recurrences. […] Both treatments are essentially a standardized version of FMT, which isn’t approved by the FDA but is recommended by several medical societies for treating patients who’ve had two or more recurrences and failed antibiotic treatment. […] More non-antibiotic options for recurrent C diff could soon be on the way. […] Ultimately, while the new wave of microbiome-restoring preventives could help break the antibiotic/recurrence cycle and reduce the use of antibiotics for rCDI, Silber and von Moltke said antibiotics are likely always going to be needed to „knock out” the C difficile bacteria before practitioners can introduce beneficial microbes to colonize the gut and restore the proper balance. […] McCollister, who’s not had another recurrence since she received Zinplava, said she’s just happy that people dealing with rCDI now have more options than she did.

• #32 Clostridioides difficile infection – Wikipedia

  https://en.wikipedia.org/wiki/Clostridioides_difficile_infection

  Monoclonal antibodies against C. difficile toxin A and C. difficile toxin B are approved to prevent recurrence of C. difficile infection including bezlotoxumab. […] Several treatment options exist for recurrent C. difficile infection. […] For patients with C. diff infections that fail to be resolved with traditional antibiotic regimens, fecal microbiome transplants boasts an average cure rate of 90%. […] In a review of 317 patients, it was shown to lead to resolution in 92% of the persistent and recurrent disease cases. […] Fecal microbiota transplant may expedite this recovery by directly replacing the missing microbial community members.

• #33 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  A second orally administered microbiota product (Vowst) received FDA approval in April 2023. Results from the ECOSPOR III phase 3 double-blind, randomized, placebo-controlled trial showed a decreased recurrence of CDI in patients treated orally with microbiota compared with placebo (12% vs 40%, respectively; P 0.001).

• #34 Breaking the cycle: New treatments for recurrent C diff offer an alternative to repeated antibiotics | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/breaking-cycle-new-treatments-recurrent-c-diff-offer-alternative-repeated

  It’s no secret that antibiotics are one of the foundations of modern medicine. […] „I took every antibiotic that there is to combat C diff, and none of them worked,” McCollister told CIDRAP News. […] While several studies have found FMT to be effective in reducing CDI recurrence, it didn’t work for McCollister. […] What ultimately cured McCollister, she said, after 18 months of dealing with rCDI, was an infusion of Zinplava (Bezlotoxumab), a human monoclonal antibody that’s designed to neutralize one of the C difficile toxins that attack the lining of the colon and is given in combination with antibiotics. […] Over the past year, two more treatments for rCDI that could help break the antibiotic/recurrence cycle have come on the market. […] The randomized controlled trials that led to the approval of the two microbiota-based drugs which are technically considered preventives showed that both significantly cut CDI recurrence compared with the standard-of-care antibiotic treatments or placebo and were well-tolerated.

• #35 Treating C. Difficile: Medicine to Prevent a Repeat Infection | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/treating-c-difficile-medicine-prevent-repeat-infection

  To treat a C. diff infection, your healthcare provider might have you stop taking the antibiotic that caused the C. diff to multiply, if possible. You will likely be given a different antibiotic to treat the C. diff. Treatment for C. diff stops the symptoms. […] If you are being treated for C. diff and are at risk for a relapse, your provider may prescribe an additional medicine. This medicine is called bezlotoxumab. In some people, it can lower the chance of the symptoms coming back. […] Bezlotoxumab has been shown to lower the risk of recurrent C. diff by about 10%. […] The medicine is a human monoclonal antibody. […] Bezlotoxumab does not treat the infection or kill the bacteria. So it’s only used along with the antibiotic medicine used to treat C. diff. […] Bezlotoxumab is a liquid medicine that is given through an IV (intravenous) line into a vein. […] You get this treatment just one time while you are taking the antibiotics.

• #36

  https://www.aast.org/resources-detail/clostridium-difficile-infection-cdi

  If severe Clostridium difficile colitis does not improve with antibiotics, surgery may be necessary. Surgery usually involves removing the majority of the colon and performing an ileostomy, where the intestinal contents empty into a plastic appliance attached to the abdominal wall. […] In addition to these prevention strategies, a variety of new treatment and prevention strategies are being researched, from new antibiotics, to fecal bacteriotherapy (stool transplant in which bacteria from one persons intestines are given to another person to help restore bacterial intestinal equilibrium), to antibodies against Clostridium difficile toxins, to vaccines. These will hopefully limit the impact of Clostridium difficile infection in the future.

• #37 Clostridium Difficile (C. Diff) Infection

  https://healthlibrary.vidanthealth.com/RelatedItems/3,89209

  C. diff (Clostridium difficile) bacteria can be very harmful. They affect the intestinal tract. They can cause symptoms ranging from mild diarrhea to severe inflammation of the large intestine (colon). […] In many cases, you will be given an antibiotic or other medicine or therapy directed at the C. diff infection. Your healthcare provider might advise that you stop taking or change the antibiotics you’ve been prescribed. Talk with your provider before stopping or starting any medicines. […] To reduce symptoms: Drink plenty of fluids to replace water lost through diarrhea. Talk with your provider or nurse about which fluids are best. […] Your provider may give you an additional treatment if your symptoms come back. Or if you’re not able to clear the C. diff infection with a standard course of treatment. This could include: A longer, decreasing course (called a taper) of treatment with the antibiotic vancomycin and metronidazole. […] A procedure (fecal transplant) in which normal fecal material is put into your intestines. This is done to give you the good bacteria again and stop the C diff infection from coming back. […] A medicine called bezlotoxumab. In some cases, it can help prevent your symptoms from returning.

• #38 Natural Remedies for C. Diff Infection – Institute for Natural Medicine

  https://naturemed.org/natural-remedies-for-c-diff-infection/

  Probiotics, which reduce the risk of C. diff-induced diarrhea by 60 percent when taken with antibiotics, restore balance to the gut microbiome. […] While antibiotics used to treat C. diff infection can disrupt the microbiome and cause gastrointestinal upset, naturopathic treatments often have fewer side effects and a lower risk of secondary infections.

• #39 Reddit – The heart of the internet

  https://www.reddit.com/r/cdifficile/comments/emv1rp/so_youve_been_diagnosed_with_c_difficile_what_now/

  If Vancomycin, Dificid, and taper methods all fail, there is still one option and strangely enough, it is the most effective: a fecal transplant (also called FMT). This method involves taking stool from a healthy donor and transplanting into your gut. Although it sounds disgusting, fecal transplants have a success rate of over 90% when used to treat cdiff. […] The only way to manage PI-IBS is to figure out which foods are irritating your gut. […] The probiotic Florastor (generic name: saccharomyces boulardii) is the gold standard for preventing cdiff recurrence and easing PI-IBS symptoms. Your doctor may recommend that you take it 1-4x a day for weeks or months after your infection, or even indefinitely if you’re high-risk (existing problems like IBS, Crohns, GERD, etc.) […] Florastor may be prescribed by your doctor in some countries, you can simply order it online. Generic forms are generally cheaper but some people report they affect them differently. Once again, you may have to experiment.

• #40 Recommendations | Clostridioides difficile infection: antimicrobial prescribing | Guidance | NICE

  https://www.nice.org.uk/guidance/ng199/chapter/Recommendations

  Do not offer bezlotoxumab to prevent recurrence of C. difficile infection because it is not cost effective. […] Consider a faecal microbiota transplant for a recurrent episode of C. difficile infection in adults who have had 2 or more previous episodes (see NICE’s interventional procedures guidance on faecal microbiota transplant for recurrent C. difficile infection). […] When prescribing antibiotics for suspected or confirmed C. difficile infection in adults, follow table 1. […] When prescribing antibiotics for suspected or confirmed C. difficile infection in children and young people under 18 years, base the choice of antibiotic on what is recommended for C. difficile infection in adults. […] Do not offer antibiotics to prevent C. difficile infection. […] Do not advise people taking antibiotics to take prebiotics or probiotics to prevent C. difficile infection.

• #41 Clostridioides difficile (C. diff) – AGA GI Patient Center

  https://patient-staging.gastro.org/clostridioides-difficile-c-diff/

  Stopping the antibiotics can commonly resolve diarrhea. However, if you continue to have diarrhea or do not improve, a stool test for C. diff should be performed. […] If C. diff is found in the stool, new antibiotic treatment will be required to clear this infection. Your doctor will order a different type of antibiotic to specifically treat the C. diff infection, usually oral vancomycin or fidaxomicin. […] Many people who take antibiotics to treat C. diff infection start to feel better within 3 days, but it is important to keep taking the medication until you finish it (usually 10–14 days). If not, it may not kill all of the C. diff, and the infection could come back (i.e., a recurrence). […] Sometimes your doctor may decide you need an additional treatment, to prevent the infection from returning. There are two types of these treatments: Bezlotoxumab: This is an intravenous medication that you receive while you are on the antibiotic to treat C. diff. It helps prevent the infection from returning by blocking the toxins that cause abdominal pains and diarrhea.

• #42 Clostridium Difficile (C. Diff): Severe Diarrhea Treatment, Symptoms & Tests

  https://www.emedicinehealth.com/clostridium_difficile_c_difficile_c_diff/article_em.htm

  Intravenous Immunoglobulin (IVIG) with C. diff antitoxin has been used in the treatment of recurrent infections, but the results are not better than the standard treatment. […] Finally, fecal bacteriotherapy (or fecal enema) has been examined in patients with severe and recurrent disease. This treatment entails the introduction of feces, containing the usual gut bacteria (gut flora) obtained from healthy individuals, directly into the colon of the infected patient. This is believed to restore the normal gut flora that was altered by the use of antibiotics. While this approach has shown some promise, the data are very limited, and the procedure may be difficult from a practical standpoint. […] Follow-up with a doctor after the completion of therapy for C. diff is strongly recommended. It is not necessary to repeat stool tests after the completion of therapy unless the symptoms persist (unresponsive to treatment) or recur after initial resolution (relapse).

• #43 How Long Does C Diff Last? Symptoms, Antibiotics, Infection

  https://www.medicinenet.com/how_long_does_c_diff_last/article.htm

  Even though Clostridium difficile (C diff) infections are caused by antibiotics, antibiotics are the treatment of choice for C diff and may include: Vancocin (Vancomycin), Fidaxomicin, Flagyl (Metronidazole). […] It can take a long time for the gut microflora to reestablish itself after the treatments. For the next two to eight weeks after the initial infection, the chances of reinfection are still high. […] Some doctors advise taking probiotics to promote the growth of beneficial bacteria. […] Fecal microbiota transplantation: Another person’s feces is introduced to the affected colon. It is possible to achieve a healthy balance of gut bacteria by adding a sample of feces containing healthy microflora. […] Surgery is sometimes required to help manage or treat a C diff infection. This is uncommon and usually occurs in the case of bowel perforation. Surgery is typically considered the last treatment option and is only considered if other forms of treatment and drugs have failed to control the infection. […] C diff infections and their complications can be incapacitating, painful, and even fatal. Some infections resolve on their own, but the threat of infection is serious for older individuals.

• #44 C. diff (Clostridium difficile): Symptoms and Treatment

  https://www.healthline.com/health/what-is-c-diff

  C. diff is commonly treated with antibiotics such as fidaxomicin (Dificid) and vancomycin (Firvanq). […] A C. diff infection is typically treated using antibiotics. However, in some cases, a doctor may also suggest a procedure known as a sigmoidoscopy to confirm the severity of the infection and perform a fecal microbiota transplant. […] Common antibiotics used to treat C. diff infections include: fidaxomicin (Dificid), metronidazole (Flagyl), vancomycin (Firvanq). […] The CDC recommends taking an antibiotic course for at least 10 days to treat a C. diff infection. […] In the case of recurrent C. diff, defined as at least two recurrences after the first episode, a fecal microbiota transplant may be considered a potential treatment option after antibiotic therapy. […] In mild cases, you can treat C. diff can at home with antibiotics. […] Most C. diff infections respond well to a 10-day course of oral antibiotic treatment. In more severe cases, you may need an IV antibiotic in addition to oral antibiotic therapy.

• #45 Can You Get C. Diff From Taking Antibiotics?

  https://health.clevelandclinic.org/antibiotics-and-c-diff

  C. diff is a severe, difficult-to-treat infection, says family medicine specialist Daniel Allan, MD. […] The main treatment for C. diff (ironically) is more antibiotics. Your provider will stop the previous antibiotic if possible and use a different type that targets C. diff like: Fidaxomicin, Vancomycin. […] If C. diff keeps coming back (recurrent C. diff), your provider may recommend additional antibiotics or a fecal microbiota transplant (FMT). FMT involves implanting healthy bacteria from a fecal donor into your large intestine. […] Regardless, probiotics are safe and inexpensive, says Dr. Allan. They may help prevent C. diff or reduce symptoms. I recommend probiotics for people taking antibiotics for more than seven days if they are worried about C. diff.

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