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Treatment of Clostridioides difficile Infection

To identify the key insights or developments described in this article
1 Credit CME

Clostridioides difficile infection is a common nosocomial and community-acquired cause of diarrhea, with an estimated 453 000 cases per year in the United States.1 Treatment of CDI is based on severity and recurrence risk.

The ACG funded the guideline and commissioned experts in the management of CDI, who collaborated with the ACG’s Practice Parameters Committee (Table). The panel disclosed potential conflicts of interest (recusal was not required). The quality of evidence and strength of recommendations were evaluated using GRADE methodology.1

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Sahil Khanna, MBBS, MS, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (khanna.sahil@mayo.edu).

Published Online: August 8, 2022. doi:10.1001/jama.2022.12251

Conflict of Interest Disclosures: Dr Khanna reported receipt of grants from Rebiotix/Ferring, Seres, Finch, and Vedanta and personal fees from Probiotech, Immuron, Niche, Jetson, Facile, and Takeda/Shire. No other disclosures were reported.

References
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Kelly  CR , Fischer  M , Allegretti  JR ,  et al.  ACG clinical guidelines: prevention, diagnosis, and treatment of Clostridioides difficile infections.   Am J Gastroenterol. 2021;116(6):1124-1147. doi:10.14309/ajg.0000000000001278PubMedGoogle ScholarCrossref
2.
Cornely  OA , Crook  DW , Esposito  R ,  et al.  Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA.   Lancet Infect Dis. 2012;12(4):281-289. doi:10.1016/S1473-3099(11)70374-7PubMedGoogle ScholarCrossref
3.
Rokas  KE , Johnson  JW , Beardsley  JR ,  et al.  The addition of intravenous metronidazole to oral vancomycin is associated with improved mortality in critically ill patients with Clostridium difficile infection.   Clin Infect Dis. 2015;61(6):934-941. doi:10.1093/cid/civ409PubMedGoogle ScholarCrossref
4.
Ianiro  G , Masucci  L , Quaranta  G ,  et al.  Faecal microbiota transplantation by colonoscopy plus vancomycin for the treatment of severe refractory Clostridium difficile infection—single versus multiple infusions.   Aliment Pharmacol Ther. 2018;48(2):152-159. doi:10.1111/apt.14816PubMedGoogle ScholarCrossref
5.
Sehgal  K , Zandvakili  I , Tariq  R ,  et al.  Systematic review and meta-analysis: efficacy of vancomycin taper and pulse regimens in Clostridioides difficile infection.   Expert Rev Anti Infect Ther. 2022;20(4):577-583. doi:10.1080/14787210.2022.1997588PubMedGoogle ScholarCrossref
6.
Cornely  OA , Miller  MA , Louie  TJ ,  et al.  Treatment of first recurrence of Clostridium difficile infection.   Clin Infect Dis. 2012;55(suppl 2):S154-S161. doi:10.1093/cid/cis462PubMedGoogle ScholarCrossref
7.
Cammarota  G , Masucci  L , Ianiro  G ,  et al.  Faecal microbiota transplantation by colonoscopy vs. vancomycin for the treatment of recurrent Clostridium difficile infection.   Aliment Pharmacol Ther. 2015;41(9):835-843. doi:10.1111/apt.13144PubMedGoogle ScholarCrossref
8.
Wilcox  MH , Gerding  DN , Poxton  IR ,  et al.  Bezlotoxumab for prevention of recurrent Clostridium difficile infection.   N Engl J Med. 2017;376(4):305-317. doi:10.1056/NEJMoa1602615PubMedGoogle ScholarCrossref
9.
Guery  B , Menichetti  F , Anttila  VJ ,  et al.  Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND).   Lancet Infect Dis. 2018;18(3):296-307. doi:10.1016/S1473-3099(17)30751-XPubMedGoogle ScholarCrossref
10.
Juul  FE , Garborg  K , Bretthauer  M ,  et al.  Fecal microbiota transplantation for primary Clostridium difficile infection.   N Engl J Med. 2018;378(26):2535-2536. doi:10.1056/NEJMc1803103PubMedGoogle ScholarCrossref
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