Clostridium Difficile Infection

Treatment

At Mayo Clinic, treatment of Clostridium difficile follows a step-wise approach, beginning with medical therapies and progressing to surgery only when necessary. Hospitalization to administer intravenous antibiotics and hydration may be necessary in some cases. In elderly patients and patients in a weakened condition, antibiotic treatment should be started even while results of diagnostic tests are pending.

Medications

Medications such as metronidazole are the first choice to treat mild to moderate C. difficile. Metronidazole has side effects and is not recommended for children or pregnant women. Vancomycin is a highly reliable but more expensive treatment; it's preferred for severely ill patients.

Relapse

Infection recurs in about 10 percent to 30 percent of patients, usually three to 10 days after finishing antibiotic treatment, though recurrence one to two months later has been noted. Risk factors for relapse include previous relapse, leukocytosis (a large increase in white blood cells in the blood), chronic renal failure, colon diverticula and recent abdominal surgery. Options for treating relapse include:

• Prolonged courses of vancomycin followed by gradual tapering
  
• Five to seven-day intermittent treatment periods with a combination of antibiotics and anion exchange resin
  
• Treatment with a combination of vancomycin and rifampin
  
• New treatments to alter or restore healthy bacteria in the colon. These regimens use oral lactobacillus GG, enemas with feces from healthy subjects and oral nonpathogenic yeast, including saccharomyces boulardii.

Surgery

Surgery may be needed to treat cases of severe disease or severe complications such as hemorrhage or bowel perforation. Surgery may also be needed when a patient's condition continues to deteriorate despite treatment with medication. Surgery carries a high risk of death, likely due to surgery being delayed until C. difficile infection is too advanced. A total abdominal colectomy (colon removal) with Brooke ileostomy is the procedure of choice.