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Treatment of refractory and recurrent Clostridium difficile infection

Christina M Surawicz1, Jacob Alexander

  • 1Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Box 359773, Seattle, WA 98104, USA. surawicz@u.washington.edu

Nature Reviews. Gastroenterology & Hepatology
|April 20, 2011
PubMed

Insights

Clostridium difficile infection (CDI) is rising, especially severe cases. This review explores treatments for recurrent and refractory CDI, including antibiotics, probiotics, fecal microbiota transplants, and immune therapies.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Gastroenterology

Background:

  • Clostridium difficile infection (CDI) incidence has increased significantly since 2000.
  • A hypervirulent strain has contributed to a rise in severe CDI cases.
  • Current guidelines recommend metronidazole for mild/moderate CDI and vancomycin for severe CDI.

Purpose of the Study:

  • To review current and emerging therapeutic strategies for refractory and recurrent Clostridium difficile infection.
  • To discuss the challenges in treating recurrent CDI.
  • To provide an overview of treatment options beyond standard antibiotic therapy.

Main Methods:

  • Literature review of therapeutic approaches for Clostridium difficile infection.
  • Analysis of treatment options for refractory and recurrent CDI.
  • Discussion of antibiotic, probiotic, fecal microbiota transplant, and immune-based therapies.

Main Results:

  • Metronidazole remains a first-line option for mild to moderate CDI.
  • Vancomycin is recommended for initial therapy in severe CDI cases.
  • Colectomy may be life-saving for medically refractory severe CDI.

Conclusions:

  • Recurrent CDI presents a significant therapeutic challenge with no single universally effective treatment.
  • A range of treatments, including antibiotics, probiotics, fecal microbiota transplantation, and immune approaches, are used for refractory and recurrent CDI.
  • Further research is needed to establish optimal treatment protocols for recurrent CDI.

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