[Clostridial colitis: diagnosis and strategies for management]

C. difficile is transmitted in a faecal-oral mode and is widespread in hospital environment. Symptoms of Clostridial infection range from asymptomatic carriage to life-threatening toxic colitis. The treatment of a Clostridial infection is dependent on the seriousness of the symptoms. The diagnosis of the pathogen as well as the introduction of an efficient antibiotic therapy is crucial. Oral metronidazole is the gold standard in treatment of mild infection. Vancomycin should be introduced only in refractory cases or in particular situations. While there is a desire to avoid colectomy, inappropriate delay in a very ill patient can be fatal. Judgement on when to intervene is difficult and requires analysis of the factors which predict outcome with and without surgery. A total abdominal colectomy sparing the rectum with end ileostomy is the procedure of choice.