Treatment of Clostridium difficileassociated diarrhoea: Guidelines

The changing epidemiology and treatment options for Clostridium difficile-associated diarrhoea (CDAD) have led to an adaptation of the practice guidelines on the treatment of CDAD. The diagnosis of CDAD is made by demonstrating toxin A and/or B (directly or indirectly) in a liquid stool sample or recording pseudomembranous colitis by means of a colonoscopy. The severity and recurrence of CDAD must guide the therapeutic choice. Mild CDAD can be treated with metronidazole, while serious CDAD must be treated with vancomycin orally. Vancomycin remains the therapy of choice for the first recurrence of CDAD. Multiple recurrences are treated with fidaxomicin, taper or pulse regimens of vancomycin or a stool transplantation to bring CDAD under control. When complications arise, like therapyresistant ileus, therapy-resistant toxic megacolon or colonic perforation, a surgical treatment is needed with a colectomy and an ileostomy.

Publication year:2015