Clostridioides difficile - Revision history

Aidan at 14:56, 8 April 2026

2026-04-08T14:56:58Z

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	* Case series suggest it may be helpful, though recurrence rate still up to 40%[[CiteRef::skinner2021a]]		* Case series suggest it may be helpful, though recurrence rate still up to 40%[[CiteRef::skinner2021a]]
	* [[~~Fidaxomicin~~]] 200 mg once daily for 7 days followed by 200 mg [[fidaxomicin]] every other day for the remaining 13 doses		* Either [[fidaxomicin]] 200 mg p.o twice daily for 10 days followed by 200 mg once daily for 7 days followed by 200 mg [[fidaxomicin]] every other day for the remaining 13 doses
			* Or fidaxomicin 200 mg p.o. twice daily for 5 days followed by 200 mg every other day for 18 days[[CiteRef::guery2018ex]]

	=== Antimobility Agents ===		=== Antimobility Agents ===

Aidan: /* Prevention */

2026-02-02T21:39:08Z

Prevention

← Older revision		Revision as of 21:39, 2 February 2026
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	* Insufficient evidence to recommend for or against[[CiteRef::2025pr]]		* Insufficient evidence to recommend for or against[[CiteRef::2025pr]]
			* [[BioK+]] has some weak observational evidence for primary prevention in a Canadian hospital[[CiteRef::maziade2015a]]

	=== Primary Prophylaxis ===		=== Primary Prophylaxis ===

Aidan: /* Probiotics */

2026-02-02T21:34:32Z

Probiotics

← Older revision		Revision as of 21:34, 2 February 2026
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	=== Probiotics ===		=== Probiotics ===

	* Insufficient evidence to recommend for or against		* Insufficient evidence to recommend for or against[[CiteRef::2025pr]]

	=== Primary Prophylaxis ===		=== Primary Prophylaxis ===

Aidan: /* Clinical Manifestations */

2026-02-02T21:32:08Z

Clinical Manifestations

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	**Thought to be related to a lack of the binding target of ''C. difficile'' toxin		**Thought to be related to a lack of the binding target of ''C. difficile'' toxin
	*Clinical disease is rare before 12 to 24 months of age		*Clinical disease is rare before 12 to 24 months of age

			=== Recurrence ===

			* About a 30% risk of recurrence, with median onset 20 days after index episode[[CiteRef::tricotel2024ep]]

	== Diagnosis ==		== Diagnosis ==

Aidan at 15:02, 2 October 2025

2025-10-02T15:02:29Z

← Older revision		Revision as of 15:02, 2 October 2025
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	===Risk factors===		===Risk factors===

	*Antibiotic exposure, typically broad-spectrum antibiotics especially those with anaerobic coverage[[CiteRef::brown2013me]]		*Antibiotic exposure, typically broad-spectrum antibiotics especially those with anaerobic coverage[[CiteRef::brown2013me]][[CiteRef::miller2023co]]
	**Highest risk oral options are [[clindamycin]], [[fluoroquinolones]] (especially with NAP1 strain), [[cephalosporins]], [[monobactams]], and [[carbapenems]]		**Highest risk oral options are [[clindamycin]], [[fluoroquinolones]] (especially with NAP1 strain), [[cephalosporins]], [[monobactams]], and [[carbapenems]]
	**Lowest risk oral options are [[tetracyclines]] and [[penicillins]]		**Lowest risk oral options are [[tetracyclines]] and [[penicillins]]

Aidan at 15:01, 2 October 2025

2025-10-02T15:01:07Z

← Older revision		Revision as of 15:01, 2 October 2025
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	*Antibiotic exposure, typically broad-spectrum antibiotics especially those with anaerobic coverage[[CiteRef::brown2013me]]		*Antibiotic exposure, typically broad-spectrum antibiotics especially those with anaerobic coverage[[CiteRef::brown2013me]]
			**Highest risk oral options are [[clindamycin]], [[fluoroquinolones]] (especially with NAP1 strain), [[cephalosporins]], [[monobactams]], and [[carbapenems]]
	**[[Clindamycin]]
			**Lowest risk oral options are [[tetracyclines]] and [[penicillins]]
	**[[Fluoroquinolones]] (especially with NAP1 strain)
			**Highest risk IV options are [[cefipime]], [[imipenem]], and [[piperacillin-tazobactam]]; possibly also other carbapenems, third-generation cephalosporins, and [[lincosamides]][[CiteRef::gilboa2025an]][[CiteRef::liu2024ri]]
	**[[Cephalosporins]]
	**[[Monobactams]]
	**[[Carbapenems]]
	*[[PPI]] use		*[[PPI]] use
	*[[Chemotherapy]]		*[[Chemotherapy]]
	*[[Hematopoietic stem cell transplantation]]		*[[Hematopoietic stem cell transplantation]]
			*''C. difficile'' carrier on screening (about 40 times more likely to get disease when exposed to antibiotics)[[CiteRef::gilboa2025an]]

	===Pathophysiology===		===Pathophysiology===

Aidan at 14:38, 2 October 2025

2025-10-02T14:38:34Z

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	*A sample '''vancomycin taper''': 125 mg po QID for 14 days, then 125 mg po TID for 7 days, then 125 mg po BID for 7 days, then 125 mg po daily for 7 days, then 125 mg po q2-3d for 2 to 8 weeks		*A sample '''vancomycin taper''': 125 mg po QID for 14 days, then 125 mg po TID for 7 days, then 125 mg po BID for 7 days, then 125 mg po daily for 7 days, then 125 mg po q2-3d for 2 to 8 weeks

	=== ~~High~~ ~~Dose Vancomycin~~ ===		=== Fulminant Infection ===
			* Standard medical treatment is oral [[vancomycin]] and intravenous [[metronidazole]]

			* May need colectomy as life-saving treatment, particularly for perforation or toxic megacolon
	* No clear data supporting high-dose [[vancomycin]], even in severe CDAD[[CiteRef::bader2020re]]		* No clear data supporting high-dose [[vancomycin]], even in severe CDAD[[CiteRef::bader2020re]]
			* [[Fidaxomicin]] can be considered[[CiteRef::heleno2021fi]]
			* [[Tigecycline]] has been considered but likely ineffective[[CiteRef::phillips2022im]]

	=== Tapered-Pulsed Fidaxomicin ===		=== Tapered-Pulsed Fidaxomicin ===

Aidan at 23:58, 20 June 2025

2025-06-20T23:58:27Z

← Older revision		Revision as of 23:58, 20 June 2025
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	* Case series suggest it may be helpful, though recurrence rate still up to 40%[[CiteRef::skinner2021a]]		* Case series suggest it may be helpful, though recurrence rate still up to 40%[[CiteRef::skinner2021a]]
	* [[Fidaxomicin]] 200 mg once daily for 7 days followed by 200 mg [[fidaxomicin]] every other day for the remaining 13 doses		* [[Fidaxomicin]] 200 mg once daily for 7 days followed by 200 mg [[fidaxomicin]] every other day for the remaining 13 doses

			=== Antimobility Agents ===

			* Once the diarrhea is being treated, there is little evidence of harm with antimobility agents[[CiteRef::koo2009an]]

	==Prevention==		==Prevention==

Aidan at 17:28, 19 September 2024

2024-09-19T17:28:58Z

← Older revision		Revision as of 17:28, 19 September 2024
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	=== High Dose Vancomycin ===		=== High Dose Vancomycin ===

	* No clear data supporting high-dose vancomycin, even in severe CDAD[[CiteRef::bader2020re]]		* No clear data supporting high-dose [[vancomycin]], even in severe CDAD[[CiteRef::bader2020re]]

	=== Tapered-Pulsed Fidaxomicin ===		=== Tapered-Pulsed Fidaxomicin ===

			* Case series suggest it may be helpful, though recurrence rate still up to 40%[[CiteRef::skinner2021a]]
	* Case series suggest it may be helpful, though recurrence rate still up to 40%<ref>Andrew M Skinner, Xing Tan, Benjamin D Sirbu, Larry H Danziger, Dale N Gerding, Stuart Johnson, A Tapered-pulsed Fidaxomicin Regimen Following Treatment in Patients With Multiple ''Clostridioides difficile'' Infection Recurrences, ''Clinical Infectious Diseases'', Volume 73, Issue 6, 15 September 2021, Pages 1107–1109, https://doi.org/10.1093/cid/ciab233</ref>
	* Fidaxomicin 200 mg once daily for 7 days followed by 200 mg fidaxomicin every other day for the remaining 13 doses		* [[Fidaxomicin]] 200 mg once daily for 7 days followed by 200 mg [[fidaxomicin]] every other day for the remaining 13 doses

	==Prevention==		==Prevention==
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	=== Secondary Prophylaxis ===		=== Secondary Prophylaxis ===

	* Oral vancomycin is occasionally used as secondary prophylaxis after a recent (within 3 to 12 months) episode of CDAD		* Oral [[vancomycin]] is occasionally used as secondary prophylaxis after a recent (within 3 to 12 months) episode of CDAD
	* Per the IDSA guidelines, there is insufficient evidence to recommend for or against		* Per the IDSA guidelines, there is insufficient evidence to recommend for or against

Aidan: /* Diagnosis */

2024-02-15T18:51:31Z

Diagnosis

← Older revision		Revision as of 18:51, 15 February 2024
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	* Usually done with either nucleic acid testing for the toxin gene, or with an EIA test for GDH and toxin A/B enzyme		* Usually done with either nucleic acid testing for the toxin gene, or with an EIA test for GDH and toxin A/B enzyme
			{\| class="wikitable"
			!Test
			!Sensitivity
			!Specificity
			\|-
			\|GDH immunoassay
			\|94-96%
			\|92-95%
			\|-
			\|Toxin A/B enzyme immunoassay
			\|58-83%
			\|99%
			\|-
			\|Parallel GDH and toxin A/B immunoassay
			\|58-82%
			\|99.5%
			\|-
			\|Toxin B PCR
			\|91-96%
			\|96-98%
			\|}

	==Management==		==Management==