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C. difficile may cause diarrhea following the production of two toxins, enterotoxin A and cytotoxin B.
C. difficile is the most common cause of nosocomial infectious diarrhea in developed countries and is the major cause of antibiotic-associated pseudo-membranous colitis. C. difficile infection (CDI) symptoms vary from asymptomatic carriage (30% of young children) to mild/moderate watery diarrhea with fever and malaise to pseudomembranous colitis with bloody diarrhea, severe abdominal pain and fever. CDI occurs almost exclusively after broad-spectrum antibiotic use. No treatment is necessary for asymptomatic carriers. Anti-motility agents are contraindicated. CDI can be treated with vancomycin 125 mg given 4 times daily for 10 days, administered orally, and fidaxomicin 200 mg given twice daily for 10 days, as first-line options for both non-severe and severe initial CDI. Patients with fulminant CDI should receive vancomycin 500 mg 4 times per day in combination with IV metronidazole. In second or subsequent recurrences, patients can be treated with oral vancomycin, fidaxomicin, or a fecal transplant. Co-administration of Saccharomyces boulardii and Lactobacillus rhamnosus during antibiotic therapy may reduce the risk of infection relapse. Oral rehydration therapy is recommended to prevent dehydration.
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