title: Rethinking Strategies to Select Antibiotic Therapy in Clostridium difficile infection.
abstract: In recent years, Clostridium difficile infection (CDI) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. Current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective components not well delineated across treatment algorithms and clinical trials. Furthermore, there is little evidence linking severity at onset to outcome. However, reducing the risk of recurrence may offer both a better outcome for the individual and decreased downstream economic impact. The authors present data supporting the opinion that patients deemed at low risk for recurrence should receive vancomycin (or metronidazole when cost is an issue), while those at higher risk of recurrence would benefit from fidaxomicin treatment. Although further prospective studies are needed, choosing treatment with the goal of preventing recurrent CDI may offer a better guide than disease severity.
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, Michigan.
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.affiliation: David Geffen School of Medicine, Los Angeles, California.|R.M. Alden Research Laboratory, Santa Monica, California.
authors.forename: Ellie J C
authors.initials: EJ
authors.lastname: Goldstein
authors.affiliation: Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Sherwood L
authors.initials: SL
authors.lastname: Gorbach
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014943:Global Health; D006801:Humans; D017410:Practice Guidelines as Topic; D011634:Public Health; D012008:Recurrence; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile infection; disease severity; fidaxomicin; recurrence