A nice review: K Rao, PDR Higgins. Inflamm Bowel Dis 2016; 22: 1744-54.
Many aspects of Clostridium difficile with and without coexisting inflammatory bowel disease has been reviewed on this blog. This review adds a few additional points:
- C difficile testing in patients with IBD, “start with enzyme immunoassay-based tests with a reflex to PCR test for discordant enzyme immunoassay results.” Rationale: “PCR is quite sensitive for the presence of toxigenic C difficile, it may increase the detection of asymptomatic colonization and shedding.”
- Don’t test for C difficile in patients in clinical remission. “Clayton et al evaluated outpatients with IBD who were in clinical remission and had no recent exposure to antimicrobials, corticosteroids, immunomodulatory agents, or hospitalizations. These patients had toxigenic C difficile carriage rates of 8.2%.”
- What to do when IBD patients test positive for C difficile infection (CDI) -treat which one or both? The authors recommend, that “if there is no response to the treatment for CDI after 48 hours, then concurrent immunologic therapy can be started/escalated.”
- Safety of FMT with IBD. “There may be additional risk incurred in the IBD population…[in a recent study] 14% of the subgroup of patients with IBD experienced adverse events including IBD flare, requiring hospitalization in some instances.” Overall, there is not enough data to “risk stratify patients in terms of these adverse outcomes.”
In addition to these pointers, advice on treatment based on severity and whether CDI is recurrent is listed on Table 1.
- For primary CDI (nonsevere): metronidazole, vancomycin or fidaxomicin.
- For primary CDI (severe): vancomycin or fidaxomicin.
- For primary CDI (severe & complicated*): vancomycin at highest dose and IV metronidazole and (if ileus present) vancomycin rectally
- Recurrent CDI: 1st recurrence — same as initial Rx, 2nd recurrence -same as initial Rx, then use either vancomycin pulsed and/or tapered regimen of 6 or more weeks
Related blog posts:
- Overdiagnosis of Clostridium difficile with PCR Assays | gutsandgrowth
- Keeping Up with Clostridium Difficile | gutsandgrowth
- What’s the best medical therapy for Clostridium difficile? | gutsandgrowth
- Consensus Guidelines on FMT | gutsandgrowth
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.