Prevention and treatment of Clostridium difficile infection

Clostridium difficile infection (CDI) is one of the most common intestinal infection often requiring hospitalization. Several risk factors are associated with the development of CDI with antibiotic treatments being the most common. Diagnosis is based on clinical suspicion, (typical symptoms associated with risk factors) and confirmatory tests, both of which are often inadequate leading to underestimation of the disease. The management of CDI is based on fluid and nutritional support, avoidance of predisposing conditions and therapeutic interventions. Therapy consists mainly in antibiotics with vancomycin and metronidazole being the most used, the former is usually reserved for severe cases or when metronidazole cannot be used. Evidence is increasing about the use of fidaxomicin, which is as effective as vancomycin but associated with lower rates of recurrences. Lastly, fecal microbiota transplantation is now recommended by most guidelines for recurrent CDI obtaining extremely higher efficacy in comparison to standard treatments.