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Guidelines

Treatment of Clostridioides difficile Infection

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JAMA

Published Online: August 8, 2022

JAMA Clinical Guidelines Synopsis

Article Information and Disclosures

Kanika Sehgal, MBBS¹;

Adam S. Cifu, MD²;

Sahil Khanna, MBBS, MS¹

Author Affiliations

¹Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
²Department of Internal Medicine, University of Chicago, Chicago, Illinois

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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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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

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.0000000000001278 PubMed Google Scholar Crossref

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)70374-7 PubMed Google Scholar Crossref

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/civ409 PubMed Google Scholar Crossref

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.14816 PubMed Google Scholar Crossref

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:10.1080/14787210.2022.1997588 PubMed Google Scholar Crossref

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/cis462 PubMed Google Scholar Crossref

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.13144 PubMed Google Scholar Crossref

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/NEJMoa1602615 PubMed Google Scholar Crossref

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-X PubMed Google Scholar Crossref

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/NEJMc1803103 PubMed Google Scholar Crossref

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
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1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
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