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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.
Author(s) and Disclosures:
Brian W. Hurley, MD has nothing to disclose. Cuong C. Nguyen, MD has nothing to disclose. Fred Arthur Zar, MD, FACP has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD; Richard Lynn, MD, FACP.

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