ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections

Abstract

Clostridioides difficile infection occurs when the bacterium produces toxin that causes diarrhea and inflammation of the colon. These guidelines indicate the preferred approach to the management of adults with C. difficile infection and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation process. In instances where the evidence was not appropriate for Grading of Recommendations Assessment, Development, and Evaluation but there was consensus of significant clinical merit, key concept statements were developed using expert consensus. These guidelines are meant to be broadly applicable and should be viewed as the preferred, but not the only, approach to clinical scenarios.

Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

“…To the best of our knowledge, this is the first systematic review and meta-analysis with trial sequential analysis addressing the clinical question of the effectiveness of OVP in CDI prevention in persons undergoing SAT. Two earlier meta-analyses have been published on the topic [ 44 , 45 ] that informed a recent guideline endorsed by the American College of Gastroenterology (ACG) [ 46 ]. ACG experts conditionally recommend OVP for secondary CDI prevention in high-risk patients undergoing SAT, although the recommendation is supported by low-quality evidence [ 46 ].…”

“…Two earlier meta-analyses have been published on the topic [ 44 , 45 ] that informed a recent guideline endorsed by the American College of Gastroenterology (ACG) [ 46 ]. ACG experts conditionally recommend OVP for secondary CDI prevention in high-risk patients undergoing SAT, although the recommendation is supported by low-quality evidence [ 46 ]. The ACG panel defines high-risk subjects as those aged 65 years or older or with significant immune system alterations who were hospitalized for severe CDI within the past three months [ 46 ].…”

“…ACG experts conditionally recommend OVP for secondary CDI prevention in high-risk patients undergoing SAT, although the recommendation is supported by low-quality evidence [ 46 ]. The ACG panel defines high-risk subjects as those aged 65 years or older or with significant immune system alterations who were hospitalized for severe CDI within the past three months [ 46 ]. Moreover, ACG guidelines suggest using low-dose vancomycin, i.e., 125 mg once daily, to be stopped five days after completion of SAT [ 46 ].…”

“…The ACG panel defines high-risk subjects as those aged 65 years or older or with significant immune system alterations who were hospitalized for severe CDI within the past three months [ 46 ]. Moreover, ACG guidelines suggest using low-dose vancomycin, i.e., 125 mg once daily, to be stopped five days after completion of SAT [ 46 ]. The latest guidelines by the Infectious Disease Society of America only focus on the use of fidaxomicin and bezlotoxumab for the treatment of CDI [ 47 ], whereas the 2021 guidelines by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) specifically address the issue of CDI prevention (clinical question number nine) [ 48 ].…”

Can probiotic fermented milk products prevent early and late complications of antibiotic therapy in young children? (Results of an open randomized clinical trial)

“…Диарея развивается после курса клиндамицина и линкомицина в 20-30% случаев, амоксициллина/клавулановой кислоты -10-25%, цефиксима -15-20%, ампициллина -5-10% и, наконец, цефалоспоринов и макролидов -в 2-5% случаев. Редко диарею вызывают фторхинолоны, а также триметоприм-сульфаметоксазол (1-2%) [2,6,7].…”