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summarize key new guideline recommendations on treatment of C diff

Answer

The key new guideline recommendations for the treatment of Clostridioides difficile infection (CDI) vary according to the severity of the disease and the specific patient context.

Non-severe disease

Severe disease

Fulminant disease

Management of recurrence

  • The ESCMID 2021 guidelines recommend administering bezlotoxumab in addition to standard-of-care antibiotic treatment or performing fecal microbiota transplantation after standard-of-care antibiotic pretreatment for a second or further CDI recurrence, depending on patient characteristics, previous treatment, local regulations, availability, and feasibility
  • The American Society of Colon and Rectal Surgeons (ASCRS) 2021 guidelines suggest offering adjunctive agents, including other antimicrobials, binding agents, and probiotics, in addition to standard treatment in patients with recurrent or refractory CDI

In summary, the treatment of Clostridioides difficile infection has evolved, with many guidelines now recommending fidaxomicin as a first-line therapy for both non-severe and severe CDI. Vancomycin remains a recommended option, especially when fidaxomicin is not available. For fulminant CDI, high-dose vancomycin combined with intravenous metronidazole is advised. The management of recurrent CDI includes newer interventions such as bezlotoxumab and fecal microbiota transplantation, tailored to patient-specific factors and resource availability.

References

1

Clostridioides difficile infection

Medical management

Guidelines

Antibiotic therapy, severe disease

Pathway
ACG 2021