Clostridium difficile-associated diarrhea: The difficulties in therapy

Clostridium difficile is a major cause of nosocomial antibiotic-associated diarrhea, with clinical features range from mild diarrhea to pseudomembrane colitis or toxic megacolon. C. difficile is frequently transmitted in healthcare setting via health medical care workers. The first step in treating patients with C. difficile infection (CDI) is discontinuing unnecessary antibiotics. Metronidazole and vancomycin have been regarded as the primary therapy options for CDI. However the choice of initial therapy depends on the severity of disease. Metronidazole is regarded as the agent of choice for most patients with mild to moderate CDI and can be administered via oral or intravenous form. Vancomycin use is recommended for those with severe CDI but can only be used via oral route. Facilitating vancomycin-resistant enterococci colonization is a potential drawback of oral vancomycin use. However, recurrent CDI was noted under either metronidazole or vancomycin use, and it is sometimes difficult to cure recurrent CDI. Probiotics and intravenous immunoglobulin are effective in some studies, but their clinic efficacy still warrants large trials. Use of some new medications, such as ramoplanin, rifaximin, nitazoxanide, fidaxomicin, or some old medications, such as fusidic acid, teicoplanin, or rifampin, in treating CDI is still under investigation. Indications for surgery include treatment failure, development of toxic megacolon or bowel perforation. Enhancement of handwashing and avoidance of unnecessary antibiotic use are commonly recommended infection control strategies. In conclusion, as CDI is increasing in health care settings, prompt recognition of cases and optimal management of infections are essential for a favorable outcome.