Clostridium difficile infection: a review of current and emerging therapies

Abstract

Clostridium difficile (C. difficile) infection (CDI) is the most common cause of ­healthcare-associated infections in US hospitals. The epidemic strain NAP1/BI/ribotype 027 accounts for outbreaks worldwide, with increasing mortality and severity. CDI is acquired from an endogenous source or from spores in the environment, most easily acquired during the hospital stay. The use of antimicrobials disrupts the intestinal microflora enabling C. difficile to proliferate in the colon and produce toxins. Clinical diagnosis in symptomatic patients requires toxin detection from stool specimens and rarely in combination with stool culture to increase sensitivity. However, stool culture is essential for epidemiological studies. Oral metronidazole is the recommended therapy for milder cases of CDI and oral vancomycin or fidaxomicin for more severe cases. Treatment of first recurrence involves the use of the same therapy used in the initial CDI. In the event of a second recurrence oral vancomycin often given in a tapered dose or intermittently, or fidaxomicin may be used. Fecal transplantation is playing an immense role in therapy of recurrent CDI with remarkable results. Fulminant colitis and toxic megacolon warrant surgical intervention. Novel approaches including new antibiotics and immunotherapy against CDI or its toxins appear to be of potential value.

Successful Therapy of Clostridium Difficile Infection with Fecal Microbiota Transplantation

“…In mild or moderate cases of CDI, the antibiotic therapy is applied for 10 -14 days with either metronidazole at a dose 500 mg on prescription or vancomycin at a dose 125 mg four times a day. For a severe or complicated form of CDI, fidaxomycin (dose 200mg two times a day) should be used (7).…”

“…The likelihood of developing further CDI episodes increases to 40 -65% if the patient already had one recurrence of the disease (6,7).…”

Clinical Profile of Clostridium Difficile Associated Diarrhea: A study from Tertiary Care Centre of South India

“…Severe disease is characterized by diarrhea, leucocytosis (>15000 cells/µL), hypoalbuminemia (<3gm/dL) and high creatinine (> 1.5 times then premorbid levels). 32 In our study we found four patients with mild, 10 with moderate and 4 with severe disease. In comparison analysis we found that presence of fever, cramps, tenesmus and hematochezia was found to be significantly associated with CDI as compared to controls.…”

Introductory Chapter: Clostridium difficile Infection Overview

“…Radiography suggestive of CDI includes polypoid mucosal thickening, haustral fold thickening or gaseous distention of the colon; however, radiographic features are not sensitive and not CDI specific [15]. Another diagnostic method is the endoscopy which is rarely required, but it may be helpful in case of doubt of CDI from the clinical signs with all the laboratory tests showed negative results or in patients with inflammatory bowel disease [16].…”