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Last Updated: 4/1/2014  

Clostridium difficile-associated Diarrhea

Prevention
  • Limit the use of antibiotics to decrease the likelihood of outbreaks of CDAD.

  • Practice meticulous hand hygiene, especially when caring for patients with diarrhea.

  • Consider probiotics to prevent CDAD in high-risk patients receiving antibiotics.

Diagnosis
  • Ask patients with diarrhea, fever, and abdominal pain about recent antibiotic use and recent health care facility exposure.

  • Test for CDAD with toxin A and B ELISA in most patients.

  • Perform flexible sigmoidoscopy to establish the diagnosis of CDAD and eliminate other possibilities, such as ischemic colitis or IBD, when urgent diagnosis is required.

Therapy
  • Stop the offending antibiotic, replenish fluids and electrolytes, and institute contact isolation.

  • Treat mild to moderate CDAD with oral metronidazole and severe CDAD with oral vancomycin.

  • Treat a first relapse of CDAD with the same agent used in the initial treatment; treat subsequent relapses with vancomycin.

  • Treat multiple relapses of CDAD with pulsed or tapering doses of vancomycin, oral fecal transplants, monoclonal antibodies or immunoglobulin, antibiotics and probiotics, or rifaximin.

  • Refer patients for subtotal colectomy and ileostomy with fulminant colitis in whom drug therapy fails or who have colonic perforation or toxic megacolon.

DOI: 10.7326/d320
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Brian W. Hurley, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Cuong C. Nguyen, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Fred Arthur Zar, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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