title: Clostridium difficile infection: clinical spectrum and approach to management.
abstract: Clostridium difficile is recognized globally as an important enteric pathogen associated with considerable morbidity and mortality due to the widespread use of antibiotics. The overall incidence of C. difficile-associated diarrhea (CDAD) is increasing due to the emergence of a hypervirulent strain known as NAP1/BI/027. C. difficile acquisition by a host can result in a varied spectrum of clinical conditions inclusive of both colonic and extracolonic manifestations. Repeated occurrence of CDAD, manifested by the sudden re-appearance of diarrhea and other symptoms usually within a week of stopping treatment, makes it a difficult clinical problem. C. difficile infection has also been reported to be involved in exacerbation of inflammatory bowel diseases. The first step in the management of a suspected CDAD case is the withdrawal of the offending agent and changing the antibiotic regimens. Antimicrobial therapy directed against C. difficile viz. metronidazole for mild cases and vancomycin for severe cases is needed. For patients with ileus, oral vancomycin with simultaneous intravenous (IV) metronidazole and intracolonic vancomycin may be given. Depending on the severity of disease, the further line of management may include surgery, IV immunoglobulin treatment or high dose of vancomycin. Adjunctive measures used for CDAD are probiotics and prebiotics, fecotherapy, adsorbents and immunoglobulin therapy. Among the new therapies fidaxomicin has recently been approved by the American Food and Drugs Administration for treatment of CDAD.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India. chetanavaishnavi@gmail.com
authors.forename: Chetana
authors.initials: C
authors.lastname: Vaishnavi
mesh_terms: D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000302:isolation & purification / Q000472:pathogenicity; D003015:Clostridium Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D019587:Dietary Supplements; D013505:Digestive System Surgical Procedures / Q000379:methods; D019468:Disease Management; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D000077732:Fidaxomicin; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000503:physiopathology; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects; D012720:Severity of Illness Index; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects; D028761:Withholding Treatment
chemical_list: D000617:Aminoglycosides; D000890:Anti-Infective Agents; D016756:Immunoglobulins, Intravenous; D008795:Metronidazole; D014640:Vancomycin; D000077732:Fidaxomicin