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Clostridium difficile Infections: Diagnosis, Treatment, and Prevention

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Comparative Effectiveness of Standard Antibiotic Treatment for CDI

The target patient population was of adult patients with clinical signs consistent with CDI in hospital, outpatient, or long-term care settings. Studies that examined the comparative effectiveness of the antimicrobial treatments by organism strain were included. The interventions that were included consisted of vancomycin, metronidazole, bacitracin, nitazoxanide, rifaximin, fidaxomicin, and rifampin. As fusidic acid and teicoplanin are not currently approved for use in the United States, these treatments were excluded. Fidaxomicin was added as an intervention because FDA approval was granted May, 2011. Desired outcomes included initial cure, recurrence (variably defined by symptoms with or without a positive test for C. difficile), and mortality, which are outcomes of interest to clinicians and are reported in most studies. Also included were time to resolution of diarrhea, which may be important because of effects on patient comfort, duration of hospitalization, and for infection control purposes. Reported harms data to patients using any of the standard antimicrobial treatments were also included.