European Practice for CDI Treatment

  • Fidelma Fitzpatrick
  • Mairead Skally
  • Melissa Brady
  • Karen Burns
  • Christopher Rooney
  • Mark H. Wilcox
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1050)

Abstract

Clostridium difficile infection (CDI) remains a significant cause of morbidity and mortality worldwide. Historically, two antibiotics (metronidazole and vancomycin) and a recent third (fidaxomicin) have been used routinely for CDI treatment; convincing data are now available showing that metronidazole is the least efficacious agent. The European Society of Clinical Microbiology and Infectious Diseases CDI treatment guidelines outline the treatment options for a variety of CDI clinical scenarios, including use of the more traditional anti-CDI therapies (e.g., metronidazole, vancomycin), the role of newer anti-CDI agents (e.g., fidaxomicin), indications for surgical intervention and for non-antimicrobial management (e.g., faecal microbiota transplantation, FMT). A 2017 survey of 20 European countries found that while the majority (n = 14) have national CDI guidelines that provide a variety of recommendations for CDI treatment, only five have audited guideline implementation. A variety of restrictions are in place in 13 (65%) countries prior to use of new anti-CDI treatments, including committee/infection specialist approval or economic review/restrictions. Novel anti-CDI agents are being evaluated in Phase III trials; it is not yet clear what will be the roles of these agents. Prophylaxis is an optimum approach to reduce the impact of CDI especially in high-risk populations; monoclonal antibodies, antibiotic blocking approaches and multiple vaccines are currently in advanced clinical trials. The treatment of recurrent CDI is particularly troublesome, and several different live bio therapeutics are being developed, in addition to FMT.

Keywords

C. difficile treatment Anti-CDI agents CDI guidelines Novel C. difficile agents C. difficile prophylaxis 

Notes

Acknowledgements

We wish to thank Mr. Myles Houlden, Health Protection Surveillance Centre for assistance with Demographix® software and the National CDI experts who took the time to complete the online survey of CDI treatment in Europe.

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Fidelma Fitzpatrick
    • 1
    • 2
  • Mairead Skally
    • 2
  • Melissa Brady
    • 2
  • Karen Burns
    • 2
    • 3
  • Christopher Rooney
    • 4
  • Mark H. Wilcox
    • 4
    • 5
  1. 1.Department of Clinical MicrobiologyThe Royal College of Surgeons in IrelandDublinIreland
  2. 2.Department of Clinical MicrobiologyBeaumont HospitalDublinIreland
  3. 3.Health Protection Surveillance CentreDublinIreland
  4. 4.MicrobiologyLeeds Teaching Hospitals and University of LeedsLeedsUK
  5. 5.Leeds Teaching Hospitals and University of LeedsLeedsUK

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