Treatment of clostridium difficile infection
- John R. Stroehlein fMD
- … show all 1 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
With the introduction of broad-spectrum antibiotics into clinical practice, Clostridium difficile infection has become the most common cause of infectious diarrhea in hospitalized patients. Although mild cases may resolve by discontinuing antibiotics, thus allowing re-establishment of colonic microflora, oral metronidazole or vancomycin is indicated if the process is more severe. Metronidazole may be given intravenously, with intracolonic therapeutic levels achieved by excretion of drug into bile and exudation across inflamed tissue. Vancomycin is preferred treatment of severe cases. Bacitracin given orally is a therapeutic alternative and cholestyramine is a useful adjunct. Most patients with diarrhea or colitis caused by C. difficile respond to initial therapy; however, up to 20% experience relapse when treatment is discontinued. Repeating initial therapy for 10 to 14 days is indicated for first relapse. Multiple relapses require prolonged treatment with vancomycin, which may be supplemented with cholestyramine. Saccharomyces boulardii alone or in combination with vancomycin has been reported to be an effective therapeutic alternative for recurrent infection. Intravenous immunoglobulin can be effective in patients with severe recurrent Clostridium difficile colitis and immune deficiency or low pretreatment levels of serum antitoxin. Surgery is indicated only if recurrent infections are severe and associated with serious complications.
- Bartlett JG, Chang TW, Gurwith M, et al.: Antibioticassociated pseudomembranous colitis due to toxinproducing clostridia. N Engl J Med 1978, 298: 531–534. CrossRef
- Larson HE, Price AB, Honour P, Borriello SP: Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet 1978, 1: 1063–1066. CrossRef
- Kelly CP, Pothoulakis C, LaMont JT: Clostridium difficile colitis. N Engl J Med 1994, 330: 257–262. CrossRef
- Borriello SP: The influence of the normal flora on Clostridium difficile colonisation of the gut. Ann Med 1990, 22: 61–67.
- Fekety R, McFarland LV, Surawicz CM, et al.: Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis 1997, 24: 324–333.
- McFarland LV, Mulligan ME, Kwok RY, Stamm WE: Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989, 320: 204–210. CrossRef
- Johnson S, Gerding DN, Olson MM, et al.: Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990, 88: 137–140. CrossRef
- Johnson S, Adelmann A, Clabots CR, et al.: Recurrences of Clostridium difficile diarrhea not caused by the original infecting organism. J Infect Dis 1989, 159: 340–343.
- Surawicz CM, Elmer GW, Speelman P, et al.: Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study. Gastroenterology 1989, 96: 981–988.
- Szajewska H, Kotowska M, Mrukowicz JZ, et al.: Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr 2001, 138: 361–365. Important study. CrossRef
- Gorbach SL, Chang TW, Goldin B: Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet 1987, 2: 1519. CrossRef
- Pothoulakis C, Kelly CP, Joshi MA, et al.: Saccharomyces boulardii inhibits Clostridium difficile toxin A binding and enterotoxicity in rat ileum. Gastroenterology 1993, 104: 1108–1115.
- Kimmey MB, Elmer GW, Surawicz CM, McFarland LV: Prevention of further recurrences of Clostridium difficile colitis with Saccharomyces boulardii. Dig Dis Sci 1990, 35: 897–901. CrossRef
- Surawicz CM, McFarland LV, Elmer G, Chinn J: Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol 1989, 84: 1285–1287.
- Lewis SJ, Freedman AR: Review article: the use of biotherapeutic agents in the prevention and treatment of gastrointestinal disease. Aliment Pharmacol Ther 1998, 12: 807–822. CrossRef
- Schwan A, Sjolin S, Trottestam U, Aronsson B: Relapsing Clostridium difficile enterocolitis cured by rectal infusion of normal faeces. Scand J Infect Dis 1984, 16: 211–215. CrossRef
- Tvede M, Rask-Madsen J: Bacteriotherapy for chronic relapsing Clostridium difficile diarrhoea in six patients. Lancet 1989, 1: 1156–1160. CrossRef
- Tedesco F, Markham R, Gurwith M, et al.: Oral vancomycin for antibiotic-associated pseudomembranous colitis. Lancet 1978, 2: 226–228. CrossRef
- Fekety R, Silva J, Kauffman C, et al.: Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. Am J Med 1989, 86: 15–19. CrossRef
- Teasley DG, Gerding DN, Olson MM, et al.: Prospective randomised trial of metronidazole versus vancomycin for Clostridium difficile-associated diarrhoea and colitis. Lancet 1983, 2: 1043–1046. CrossRef
- Chang TW, Gorbach SL, Bartlett JG, Saginur R: Bacitracin treatment of antibiotic-associated colitis and diarrhea caused by Clostridium difficile toxin. Gastroenterology 1980, 78: 1584–1586.
- Kelly CP: Immune response to Clostridium difficile infection. Eur J Gastroenterol Hepatol 1996, 8: 1048–1053.
- Warny M, Vaerman JP, Avesani V, Delmee M: Human antibody response to Clostridium difficile toxin A in relation to clinical course of infection. Infect Immun 1994, 62: 384–389.
- Aronsson B, Granstrom M, Mollby R, Nord CE: Serum antibody response to Clostridium difficile toxins in patients with Clostridium difficile diarrhoea. Infection 1985, 13: 97–101. CrossRef
- Leung DY, Kelly CP, Boguniewicz M, et al.: Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J Pediatr 1991, 118(4 pt 1):633–637. CrossRef
- Salcedo J, Keates S, Pothoulakis C, et al.: Intravenous immunoglobulin therapy for severe Clostridium difficile colitis. Gut 1997, 41: 366–370. CrossRef
- Saginur R, Hawley CR, Bartlett JG: Colitis associated with metronidazole therapy. J Infect Dis 1980, 141: 772–774.
- Treatment of clostridium difficile infection
Current Treatment Options in Gastroenterology
Volume 7, Issue 3 , pp 235-239
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links
- Author Affiliations
- 1. M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 436, 77030-4009, Houston, TX, USA