Clostridium difficile Infections: Diagnosis, Treatment, and Prevention
Overall Conclusions: Nonstandard Interventions to Treat CDI or Reduce the Risk of Recurrence
The conclusions for nonstandard interventions to treat CDI and/or reduce the risk of recurrent infections are limited by the lack of comparative studies available and generally have a low strength of evidence. Current research suggests that:
- C. difficile immune whey is well tolerated and may prevent recurrence of CDI at rates similar to metronidazole.
- Fecal flora reconstitution via fecal transplantation may prevent recurrent infections for up to 1 year.
- Probiotics, prebiotics, and toxin-neutralizing antibodies alone may not reduce CDI incidence rates.
- An oligofructose prebiotic (low strength of evidence) and toxin-neutralizing antibodies (moderate strength of evidence) have the potential to help reduce the risk of recurrent infections.
- Butler M, Bliss D, Drekonja D, Filice G, Rector T, MacDonald R, Wilt T. Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection. Comparative Effectiveness Review No. 31 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 11(12)-EHC051-EF. Rockville, MD. Agency for Healthcare Research and Quality. December 2011. Available at: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=772.
- Lewis S, Burmeister S, Brazier J. Effect of the prebiotic oligofructose on relapse of Clostridium difficile-associated diarrhea: a randomized, controlled study. Clin Gastroenterol Hepatol 2005 May; 3(5):442-8.
- Lowy I, Molrine DC, Leav BA, et al. Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med 2010 Jan 21; 362(3):197-205.
- MacConnachie AA, Fox R, Kennedy DR, et al. Faecal transplant for recurrent Clostridium difficile-associated diarrhoea: a UK case series. QJM 2009 Nov; 102(11):781-4.
- Mattila E, Anttila VJ, Broas M, et al. A randomized, double-blind study comparing Clostridium difficile immune whey and metronidazole for recurrent Clostridium difficile-associated diarrhoea: efficacy and safety data of a prematurely interrupted trial. Scand J Infect Dis 2008; 40(9):702-8.
- Persky SE, Brandt LJ. Treatment of recurrent Clostridium difficile-associated diarrhea by administration of donated stool directly through a colonoscope. Am J Gastroenterol 2000 Nov; 95(11):3283-5.
- Rohlke F, Surawicz C, Stollman N. Fecal flora reconstitution for recurrent clostridium difficile infection: results and methodology. J Clin Gastroenterol 2010; 44(8):567-70.
- Silverman MS, Davis I, Pillai DR. Success of self-administered home fecal transplantation for chronic Clostridium difficile infection. Clin Gastroenterol Hepatol 2010 May; 8(5):471-3.
- Tvede M, Rask-Madsen J. Bacteriotherapy for chronic relapsing Clostridium difficile diarrhoea in six patients. Lancet 1989 May 27; 1(8648):1156-60.
- Yoon S, Brandt L. Treatment of refractory/recurrent C. difficile-associated disease by donated stool transplanted via colonoscopy: a case series of 12 patients. J Clin Gastroenterol 2010; 44(8):562-6.
Your slide tray is being processed.