How is C. difficile treated?
Antibiotic and Supportive Treatment
When treating C. difficile infection, the first step is to stop taking the antibiotic which caused the infection or switch to an antibiotic that is less associated with C. difficile (24). Following this, treatment may include oral antibiotics which prevent C. difficile bacteria from growing and in turn alleviates diarrhea and other symptoms (24). The most common antibiotics used are vancomycin and fidaxomicin (25) for a standard course of 10 days, which can change depending on the individual needs of the patient. Metronidazole is an alternative antibiotic that may be prescribed but is avoided in patients with advanced age, as well as those who are infirm or develop a C. difficile infection in association with inflammatory bowel disease (26). The most important thing is to take the antibiotics regularly and finish the entire course.
Patients are also recommended to drink adequate fluids with water, salt, and sugar to counteract the loss of fluid from diarrhea (27). Keeping up nutrition is also important; for diarrhea, foods that contain boiled starches and cereals (potatoes, noodles, oats, wheat) with salt are recommended in the short-term only (27). Bananas, crackers, soup, and boiled vegetables are also good options (27).
Treatment of Severe Cases
More severe cases of C. difficile are admitted to the hospital with intravenous or oral antibiotics as well as intravenous fluids to support for dehydration (24). In patients suffering from severe pain, organ failure, or colitis [inflammation of the abdominal lining], or those that are showing signs of colon perforation of toxic megacolon, surgery can be performed to remove the part of the colon which is diseased, known as a colectomy (24). However, surgery is rarely performed (only 2-3% of patients), as most cases of C. difficile infection are treated with medical therapies (28).
Recurrent Infections
However, some patients will get a recurrent infection due to reinfection or ineffective elimination of the first infection (24). Recurrence risks increase with age, taking antibiotics for other infections, and are associated with other underlying medical disorders (24). To treat recurrent infection, a different antibiotic would be involved (24). It is important to note that antibiotic therapy loses efficacy with each subsequent recurrence.
Fecal Microbiota Transplant and Probiotics
Fecal microbiota transplant (FMT) is another emerging treatment option. Clinical trials have shown that FMT can successfully restore a patient's healthy intestinal microbiota by placing a specific donor’s stool into the patient’s colon (24). The use of FMT for recurrent C. difficile infection has been shown to be safe and effective and is recommended as a therapeutic option following a third recurrence (24).
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The use of probiotics which are organisms, like bacteria and yeast, has been suggested as a way to restore the intestinal microbiota (24). However, there is currently a lack of evidence and clinical trial data that probiotics can decrease C. difficile infection. Severe limitations exist in the available data such as: differences in probiotic formulations studied, the duration and dosage of probiotic administration, definitions and categorization of C. difficile infection, and the patient population that was selected to be studied (29). As such, they are currently not recommended in routine use (24).
References
24. Peng Z, Ling L, Stratton CW, Li C, Polage CR, Wu B, et al. Advances in the diagnosis and treatment of Clostridium difficile infections. Emerg Microbes Infect. 2018;7(1):15.
25. Nelson RL, Suda KJ, Evans CT. Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. The Cochrane Database of Systematic Reviews. 2017;3(3):CD004610-CD.
26. Khanna S, Shin A, Kelly CP. Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017;15(2):166-74.
27. Scheidler MD, Giannella RA. Practical Management of Acute Diarrhea. Hospital Practice. 2001;36(7):49-56.
28. Steele SR, McCormick J, Melton GB, Paquette I, Rivadeneira DE, Stewart D, et al. Practice parameters for the management of Clostridium difficile infection. Diseases of the colon and rectum. 2015;58(1):10-24.
29. Pillai A, Nelson R. Probiotics for treatment of Clostridium difficile-associated colitis in adults. Cochrane Database Syst Rev. 2008(1):Cd004611.
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