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Treatments and drugs
By Mayo Clinic staffThe first step in treating C. difficile is to stop taking the antibiotic that triggered the infection, when possible. Depending on the severity of your infection, treatment may include:
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Antibiotics. Ironically, the standard treatment for C. difficile is another antibiotic. These antibiotics keep C. difficile from growing, which treats diarrhea and other complications.
For mild to moderate infection, doctors usually prescribe metronidazole (Flagyl), taken by mouth. Metronidazole is not FDA approved for C. difficile infection, but has been shown to be effective in mild to moderate infection. Side effects of metronidazole include nausea and a bitter taste in your mouth.
For more severe and recurrent cases, vancomycin (Vancocin), also taken by mouth, may be prescribed.
Another oral antibiotic, fidaxomicin (Dificid), has been approved to treat C. difficile. In one study, the recurrence rate of C. difficile in people who took fidaxomicin was lower than among those who took vancomycin. However, fidaxomicin costs considerably more than metronidazole and vancomycin. Common side effects of vancomycin and fidaxomicin include abdominal pain and nausea.
- Surgery. For people with severe pain, organ failure or inflammation of the lining of the abdominal wall, surgery to remove the diseased portion of the colon may be the only option.
Recurrent infection
Up to 20 percent of people with C. difficile get sick again, either because the initial infection never went away or because they're reinfected with a different strain of the bacteria. But after one or more recurrences, rates of further recurrence increase up to 65 percent.
Your risk of recurrence is higher if you:
- Are older than 65
- Are taking other antibiotics for a different condition while being treated with antibiotics for C. difficile infection
- Have a severe underlying medical disorder, such as chronic kidney failure, inflammatory bowel disease or chronic liver disease
Treatment for recurrent disease may include:
- Antibiotics. Antibiotic therapy for recurrence may involve one or more courses of a medication (typically vancomycin), a gradually tapered dose of medication or an antibiotic given once every few days, a method known as a pulsed regimen. For a first recurrence, the effectiveness of antibiotic therapy is around 60 percent and further declines with each subsequent recurrence.
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Fecal microbiota transplant (FMT). Also known as a stool transplant, FMT is emerging as an alternative strategy for treating recurrent C. difficile infections. Though not yet approved by the FDA, clinical studies of FMT are currently underway.
FMT restores healthy intestinal bacteria by placing another person's (donor's) stool in your colon, using a colonoscope or nasogastric tube. Donor stools are carefully and repeatedly screened for parasites, viruses, bacteria and certain antibodies before being used for an FMT.
Research has shown FMT has a success rate higher than 90 percent for treating C. difficile infections. One small, randomized, controlled trial stopped early because the results were so positive, with a 94 percent success rate overall.
- Probiotics. Probiotics are organisms, such as bacteria and yeast, which help restore a healthy balance to the intestinal tract. A yeast called Saccharomyces boulardii, in conjunction with antibiotics, might help prevent further recurrent C. difficile infections.
- Khanna S, et al. Clostridium difficile infection: New insights into treatment. Mayo Clinic Proceedings. 2012;87:1106.
- Rebmann T, et al. Preventing Clostridium difficile infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology's elimination guide. American Journal of Infection Control. 2011;39:239.
- LaMont JT. Clostridium difficile in adults: Epidemiology, microbiology, and pathophysiology. http://www.uptodate.com/home. Accessed March 25, 2013.
- Kelly CP, et al. Clostridium difficile in adults: Treatment. http://www.uptodate.com/home. Accessed March 25, 2013.
- Frequently asked questions about Clostridium difficile for healthcare providers. Centers for Disease Control and Prevention. http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html. Accessed March 25, 2013.
- Headley CM. Deadly diarrhea: Clostridium difficile infection. Nephrology Nursing Journal. 2012;30:459.
- LaMont JT. Clostridium difficile in adults: Clinical manifestations and diagnosis. http://www.uptodate.com/home. Accessed March 25, 2013.
- Surawicz CM, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. The American Journal of Gastroenterology. In press. Accessed March 25, 2013.
- Armstrong GD, et al. A potential new tool for managing Clostridium difficile infection. The Journal of Infectious Diseases. In press. Accessed March 25, 2013.
- Venugopal AA, et al. Current state of Clostridium difficile treatment options. Clinical Infectious Diseases. 2012;55:S71.
- Vancomycin hydrochloride. Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 27, 2013.
- Fidaxomicin. Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 27, 2013.
- Van Nood E, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. New England Journal of Medicine. 2013;368:407.
- Diarrhea. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/#treated. Accessed March 27, 2013.
- Clostridium difficile and C. difficile toxin testing. Lab Tests Online. http://labtestsonline.org/understanding/analytes/cdiff/tab/test. Accessed April 15, 2013.
- Public workshop: Fecal microbiota for transplantation. U.S. Food and Drug Administration. http://www.fda.gov/BiologicsBloodVaccines/NewsEvents/WorkshopsMeetingsConferences/ucm341643.htm. Accessed April 15, 2013.
- Steckelberg JM (expert opinion). Mayo Clinic, Rochester, Minn. April 16, 2013.
- Khanna S, et al. The epidemiology of community-acquired Clostridium difficile infection: A population-based study. The American Journal of Gastroenterology. 2012;107: 89.
- Khanna S (expert opinion). Mayo Clinic, Rochester, Minn. April 17, 2013.
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