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01-02-2014 | Clinical and Epidemiological Study

Treatment of recurrent Clostridium difficile infection: a systematic review

Authors: J. C. O’Horo, K. Jindai, B. Kunzer, N. Safdar

Published in: Infection | Issue 1/2014

Abstract

Background

Clostridium difficile infection (CDI) recurs in nearly one-third of patients who develop an initial infection. Recurrent CDI (RCDI) is associated with considerable morbidity, mortality, and cost. Treatment for RCDI has not been not well examined.

Methods

A systematic review.

Results

Sixty-four articles were identified evaluating eight different treatment approaches: metronidazole, vancomycin, fidaxomicin, nitazoxanide, rifampin, immunoglobulins, probiotics, and fecal bacteriotherapy. The meta-analysis found vancomycin to have a similar efficacy to metronidazole, although studies used varying doses and durations of therapy. Fidaxomicin was slightly more efficacious than vancomycin, though the number of studies was small. Good evidence for probiotics was limited. Fecal bacteriotherapy was found to be highly efficacious in a single randomized trial.

Conclusion

Metronidazole and vancomycin have good evidence for use in RCDI but heterogeneity in treatment duration and dose precludes robust conclusions. Fidaxomicin may have a role in treatment, but evidence is limited to subgroup analyses. Fecal bacteriotherapy was the most efficacious. Saccharomyces boulardii may have a role as adjunctive treatment.

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Title: Treatment of recurrent Clostridium difficile infection: a systematic review
Authors: J. C. O’Horo
K. Jindai
B. Kunzer
N. Safdar
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: Infection / Issue 1/2014
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-013-0496-x

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Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units

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Genotypic testing on HIV-1 DNA as a tool to assess HIV-1 co-receptor usage in clinical practice: results from the DIVA study group

Erratum to: An Italian consensus for invasive candidiasis management (ITALIC)

Chryseobacterium indologenes central nervous system infection in infancy: an emergent pathogen?

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page