Carrying C.<unk>  without symptoms is common. Treatment in those without symptoms is controversial. In general, mild cases do not require specific treatment. Oral rehydration therapy is useful in treating dehydration associated with the diarrhea. Medications Several different antibiotics are used for C.<unk> , with the available agents being more or less equally effective. Vancomycin or fidaxomicin by mouth are the typically recommended for mild, moderate, and severe<unk> s. They are also the first-line treatment for pregnant women, especially since metronidazole may cause birth defects. Typical vancomycin is taken four times a day by mouth for 10 days. It may also be given rectally if the person develops an ileus. Fidaxomicin is tolerated as well as vancomycin, and may have a lower risk of recurrence. Fidaxomicin has been found to be as effective as vancomycin in those with mild to moderate disease, and it may be better than vancomycin in those with severe disease. Fidaxomicin may be used in those who have recurrent<unk> s and have not responded to other antibiotics. Metronidazole by mouth is recommended as an alternative treatment only for C.<unk><unk> s when the affected person is allergic to first-line treatments, is unable to tolerate them, or has financial difficulties preventing them from accessing them. In fulminant disease vancomycin by mouth and intravenous metronidazole are commonly used together. Medications used to slow or stop diarrhea, such as loperamide, have been thought to have the potential to worsen C.<unk>  disease, and they are not generally recommended. Evidence to support worse outcomes with use however is poor. Cholestyramine, an ion-exchange resin, is effective in binding both toxin A and B, slowing bowel motility, and helping prevent dehydration. Cholestyramine is recommended with vancomycin. A last-resort treatment in those who are immunosuppressed is intravenous immunoglobulin. Monoclonal antibodies against C.<unk>  toxin A and C.<unk>  toxin B are approved to prevent recurrence of C.<unk><unk>  including bezlotoxumab. Probiotics Evidence to support the use of probiotics in the treatment of active disease is insufficient. Researchers have recently begun taking a mechanical approach to fecal-derived products. It is known that certain microbes with 7α-dehydroxylase activity can metabolize primary to secondary bile acids, which inhibit C.<unk> . Thus, incorporating such microbes into therapeutic products such as probiotics may be protective, although more pre-clinical investigations are needed. Stool transplant Fecal microbiota transplant, also known as a stool transplant, is roughly 85% to 90% effective in those for whom antibiotics have not worked. It involves infusion of the microbiota acquired from the feces of a healthy donor to reverse the bacterial imbalance responsible for the recurring nature of the<unk> . The procedure replenishes the normal colonic microbiota that had been wiped out by antibiotics, and re-establishes resistance to colonization by<unk><unk> . Side effects, at least initially, are few. Some evidence looks hopeful that fecal transplant can be delivered in the form of a pill. They are available in the United States, but are not FDA-approved as of 2015. Surgery In those with severe C.<unk>  colitis, colectomy may improve the outcomes. Specific criteria may be used to determine who will benefit most from surgery. Recurrent<unk>  Recurrent CDI occurs in 20 to 30% of the patients, with increasing rates of recurrence with each subsequent episode. In clinical settings, it is virtually impossible to distinguish a recurrence that develops as a relapse of CDI with the same strain of C.<unk>  versus reinfection that is the result of a new strain. Several treatment options exist for recurrent C<unk><unk> . For the first episode of recurrent C<unk><unk> , the 2017 IDSA guidelines recommend oral vancomycin at a dose of 125 mg four times daily for 10 days if metronidazole was used for the initial episode. If oral vancomycin was used for the initial episode, then a prolonged oral vancomycin pulse dose of 125 mg four times daily for 10-14 days followed by a taper (twice daily for one week, then every two to three days for 2-8 weeks) or fidaxomicin 200 mg twice daily for 10 days. For a second recurrent episode, the IDSA recommends options including the aforementioned oral vancomycin pulse dose followed by the prolonged taper; oral vancomycin 125 mg four times daily for 10 days followed by rifaximin 400 mg three times daily for 20 days; fidaxomicin 200 mg twice daily for 10 days, or a fecal microbiota transplant. For patients with C. diff<unk> s that fail to be resolved with traditional antibiotic regimens, fecal microbiome transplants boasts an average cure rate of >90%. In a review of 317 patients, it was shown to lead to resolution in 92% of the persistent and recurrent disease cases. It is clear that restoration of gut flora is paramount in the struggle against recurrent CDI. With effective antibiotic therapy, C.<unk>  can be reduced and natural colonization resistance can develop over time as the natural microbial community recovers. Reinfection or recurrence may occur before this process is complete. Fecal microbiota transplant may expedite this recovery by directly replacing the missing microbial community members. However, human-derived fecal matter is difficult to standardize and has multiple potential risks, including the transfer of<unk> s material and long-term consequences of inoculating the gut with a foreign fecal material. As a result, further research is necessary to study the long term effective outcomes of FMT.
Clostridioides difficile infection
Antibiotic-associated diarrhea
Irritable bowel syndrome
Campylobacteriosis
Gay bowel syndrome
Wilderness-acquired diarrhea
Factitious diarrhea
Cytomegalovirus colitis