Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

New IDSA/SHEA Clostridium Difficile Guidelines

Clin Infect Dis; ePub 2018 Feb 15; McDonald, et al

New diagnostic methods and treatments—including fecal transplantation—will help improve the care of patients with Clostridium difficile (C. diff.), according to updated guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). The guidelines were last published in 2010. They include new recommendations for treatment when warranted, including:

  • Vancomycin or fidaxomicin: Antibiotics vancomycin or fidaxomicin should be used for initial treatment of even mild C. diff., rather than metronidazole, which the previous guidelines recommended as first-line therapy. Research shows the cure rates are higher for vancomycin and fidaxomicin than for metronidazole.
  • Fecal microbiota transplantation (FMT): The guidelines recommend FMT for treatment of people with ≥2 recurrences of C. diff. and for whom traditional antibiotic treatment has not worked.
  • The guidelines include the same suggestions for preventing the spread of C. diff. as the 2010 guidelines—including isolating infection patients.
  • The guidelines make no recommendation for the use of probiotics.
  • The new guidelines also include recommendations for epidemiology, diagnosis, and treatment of C. diff. in children.

Citation:

McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). [Published online ahead of print February 15, 2018]. Clin Infect Dis. doi:10.1093/cid/cix1085.

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