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What Are the Treatments for Clostridium Difficile?

May 17, 2010 | By Laura Altobelli, MS

Clostridium difficile infection, or CDI, causes approximately one-third of the cases of infectious diarrhea in hospitals and nursing homes in the United States. The infection frequently strikes after someone receives an antibiotic that disrupts the bacteria that normally reside in the gastrointestinal system. As a result, mild cases of CDI may go away on their own if the original antibiotic is discontinued and these "good" bacteria are allowed to recover. In more severe cases, proper treatment is needed to prevent relapses.

Metronidazole

Metronidazole, which is sold under the brand name of Flagyl, is the common first-line treatment for mild cases of CDI. Typically, the drug is given in pill form at a dose of 500mg three times daily for 10 days. Because CDI often recurs after treatment is complete, infectious disease experts continue to explore whether patients should be given the same drug or a different one if symptoms return. Current guidelines recommend that metronidazole also be used for these first recurrences unless the patient's symptoms have significantly worsened.

Vancomycin

Vancomycin, which is marketed under the name Vancocin, was the first antibiotic found to be effective for treating cases of CDI, but the drug is much more expensive than metronidazole. Research has shown that both drugs work equally well as first-line treatments, but Infectious Disease News reports that some experts recommend using vancomycin for severe infection. Vancomycin is also the preferred treatment for persistent cases of CDI and for women who are pregnant or breast feeding.

Nitazoxanide

More commonly used to treat a gastrointestinal illness called giardiasis, nitazoxanide has been explored as an alternative therapy for CDI in patients who have not responded to conventional treatment. In a small study conducted by researchers from Michael E. DeBakey Veterans Affairs Medical Center in Houston, nitazoxanide was given to 35 patients whose symptoms had not responded to metronidazole therapy. Nearly three-fourths of these patients saw their symptoms fade within three days and more than half were still symptom-free 60 days later. Nitazoxanide is marketed under the names Alinia and Annita.

Alternative Approaches

Research is ongoing to determine whether the live bacteria and fungi known as probiotics may help to restore "good" bacteria to the gastrointestinal tract during CDI. Although probiotics have been found to be effective for treating other types of illnesses, researchers at the Cleveland Clinic have not found evidence to support their use in this setting. The value of probiotics found in yogurt and over-the-counter preparations is particularly hard to determine because the organisms often don't survive the trip from the factory to the grocery store shelf.
When CDI does not respond to drug therapy, patients may become willing to take extreme measures to relieve their symptoms. In one such approach---fecal implantation---a healthy family member donates stool that is then administered to the patient through a tube inserted into the nose and down the throat. Loyola University's Dale Gerding, MD, admits that fecal implants are unappealing, but they are extremely effective "if you can find someone who can do it."

Surgical Intervention

Patients older than 75 or who have very high white blood cell counts are at high risk for complications from CDI. In such patients, partial or total colectomy, or removal of the intestine, may be beneficial. An experienced surgeon should evaluate patients---more than once, if necessary---if antibiotics seem to be ineffective.

References

Article reviewed by Libby Swope Wiersema Last updated on: May 17, 2010

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