title: Management ofClostridium difficileInfection.
abstract: Since the discovery ofClostridium difficileinfection (CDI) in the 1970s, there has been an increase in the incidence, severity, and recurrence rate of the disease. We reviewed the recent CDI literature in PubMed published before February 28, 2016 that focused on advances in therapy. Despite a large number of studies describing methods for diagnosing the disease, there is currently no definitive test that identifies this infection with certainty, which complicates therapy. Recommended therapy for CDI includes oral metronidazole for mild cases and oral vancomycin or fidaxomicin for moderate to severe cases, each given for 10 to 14 days. For infection with spore-formingC difficile, this length of treatment may be insufficient to lead to cure; however, continuing antibiotics for longer periods of time may unfavorably alter the microbiome, preventing recovery. Treatment with metronidazole has been associated with an increasing failure rate, and the only clear recommended form of metronidazole for treatment of CDI is the intravenous formulation for patients unable to take oral medications. For vancomycin or fidaxomicin treatment of first CDI recurrences, the drug used in the initial bout can be repeated. For second or future recurrences, vancomycin can be given in pulsed or tapered doses. New modalities of treatment, such as bacteriotherapy and immunotherapy, show promise for the treatment of recurrent CDI.
authors.affiliation: Dr Al-Jashaami is a clinical assistant professor at the University of Arizona College of Medicine in Phoenix, Arizona. Dr DuPont is a professor and director of the Center for Infectious Diseases at the University of Texas Houston School of Public Health and the McGovern Medical School in Houston, Texas; president of the Kelsey Research Foundation in Houston, Texas; and a clinical professor at Baylor College of Medicine in Houston, Texas.
authors.forename: Layth S
authors.initials: LS
authors.lastname: Al-Jashaami
authors.affiliation: Dr Al-Jashaami is a clinical assistant professor at the University of Arizona College of Medicine in Phoenix, Arizona. Dr DuPont is a professor and director of the Center for Infectious Diseases at the University of Texas Houston School of Public Health and the McGovern Medical School in Houston, Texas; president of the Kelsey Research Foundation in Houston, Texas; and a clinical professor at Baylor College of Medicine in Houston, Texas.
authors.forename: Herbert L
authors.initials: HL
authors.lastname: DuPont
keywords: Antibiotic-associated diarrhea; Clostridium difficile infection; fecal microbiota transplantation; monoclonal antibodies; oral vancomycin