title: Treatment of recurrent Clostridium difficile infection: a systematic review.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) recurs in nearly one-third of patients who develop an initial infection. Recurrent CDI (RCDI) is associated with considerable morbidity, mortality, and cost. Treatment for RCDI has not been not well examined.
  
  
  METHODS
  A systematic review.
  
  
  RESULTS
  Sixty-four articles were identified evaluating eight different treatment approaches: metronidazole, vancomycin, fidaxomicin, nitazoxanide, rifampin, immunoglobulins, probiotics, and fecal bacteriotherapy. The meta-analysis found vancomycin to have a similar efficacy to metronidazole, although studies used varying doses and durations of therapy. Fidaxomicin was slightly more efficacious than vancomycin, though the number of studies was small. Good evidence for probiotics was limited. Fecal bacteriotherapy was found to be highly efficacious in a single randomized trial.
  
  
  CONCLUSIONS
  Metronidazole and vancomycin have good evidence for use in RCDI but heterogeneity in treatment duration and dose precludes robust conclusions. Fidaxomicin may have a role in treatment, but evidence is limited to subgroup analyses. Fecal bacteriotherapy was the most efficacious. Saccharomyces boulardii may have a role as adjunctive treatment.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: O'Horo
authors.forename: K
authors.initials: K
authors.lastname: Jindai
authors.forename: B
authors.initials: B
authors.lastname: Kunzer
authors.forename: N
authors.initials: N
authors.lastname: Safdar
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D001691:Biological Therapy / Q000379:methods; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000382:microbiology*; D003967:Diarrhea / Q000188:drug therapy* / Q000382:microbiology*; D004358:Drug Therapy / Q000379:methods; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D055502:Secondary Prevention; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D014640:Vancomycin