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Treatment of recurrent Clostridium difficile-associated disease

Nature Clinical Practice Gastroenterology & Hepatology volume 1, pages 32–38 (2004)Cite this article

Abstract

Recurrent Clostridium difficile-associated disease (RCDAD) is a difficult treatment problem—once a patient has one recurrence of the disease the likelihood of further recurrences is markedly increased. Repeat antibiotics are usually indicated, either metronidazole or vancomycin. Tapering and pulsing the antibiotic dose after a 10-day standard course decreases the incidence of recurrences compared with abruptly stopping antibiotics after a simple 10-day course. If recurrences continue after two courses of metronidazole, vancomycin may be preferable to avoid the risk of neurotoxicity that is associated with prolonged metronidazole use. There is also a role for probiotics in the treatment of RCDAD; Saccharomyces boulardii has been shown to decrease recurrences by about 50%, especially when combined with high-dose vancomycin. Other microbiologic approaches include the restoration of normal colonic flora by fecal enema or by nasogastric tube, but these have not been studied in controlled trials. In addition, there are numerous new treatment approaches that are under development, including a vaccine, which promise to aid the future treatment of RCDAD as well as prevention of initial CDAD.

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Figure 1: Strategy for treating recurrent Clostridium difficile-associated disease.

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Acknowledgements

The author is grateful to Susan Sperline for expert manuscript preparation.

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Authors and Affiliations

  1. Professor of Medicine at the University of Washington School of Medicine and Section Chief of Gastroenterology at Harborview Medical Center, Seattle, WA, USA

    Christina M Surawicz

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  1. Christina M Surawicz
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Correspondence to Christina M Surawicz.

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Competing interests

The author declares that she has received financial support for research from Biocodex Inc., Seattle, USA, but not in the past three years, and is currently a member of their Speaker's Bureau.

Glossary

RANDOMLY AMPLIFIED POLYMORPHIC DNA TYPING

Identifies different Clostridium difficile strains and provides epidemiologic information

ILEUS

Bowel dysfunction (i.e. temporary paralysis), with decreased transit and subsequent dilation, but without a true occlusion

PROBIOTIC

In veterinary terms, a live microbial feed that benefits the host animal by improving its microbial balance

PSEUDOMEMBRANOUS COLITIS

Severe colitis, usually caused by Clostridium difficile, with yellow plaques (pseudomembranes) on the surface of the colon mucosa

BACTERIOCIN

A high-molecular-weight protein produced by bacteria that suppresses the growth of pathogens in vitro

IMMUNOBLOT TYPE 1 AND 2 STRAINS

Toxin-producing Clostridium difficile strains detected by immunoblot typing and associated with recurrent C. difficile-associated disease

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Surawicz, C. Treatment of recurrent Clostridium difficile-associated disease. Nat Rev Gastroenterol Hepatol 1, 32–38 (2004). https://doi.org/10.1038/ncpgasthep0018

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