title: Treatment of refractory and recurrent Clostridium difficile infection.
abstract: The incidence of Clostridium difficile infection (CDI) has increased since 2000, with greater numbers of severe cases reported, in part due to the emergence of a hypervirulent strain. Initial therapy with metronidazole is still recommended for mild to moderate CDI, but vancomycin is recommended for first-line therapy of severe CDI. Colectomy could be life-saving for some patients with severe disease that does not respond to maximal medical therapy. Recurrent CDI is a challenge to treat; no single effective therapy currently exists. Treatments include antibiotics, adjunct probiotics, fecal microbiota transplant and immune approaches. This Review discusses the various therapeutic approaches used for the treatment of refractory and recurrent CDI.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Box 359773, Seattle, WA 98104, USA. surawicz@u.washington.edu
authors.forename: Christina M
authors.initials: CM
authors.lastname: Surawicz
authors.forename: Jacob
authors.initials: J
authors.lastname: Alexander
mesh_terms: D016360:Clostridioides difficile; D003082:Colectomy; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D008795:Metronidazole; D014640:Vancomycin