Treatment of C. difficile

Rapid diagnosis and appropriate treatment are critical to patient care and infection control. Treatment protocols have changed over time and vary from source to source. However, two principles should guide decisions:

1. Empiric treatment of CDI without a confirming test is inappropriate because only ~15% of hospitalized patients with diarrhea have CDI.⁵
2. As the incidence of severe CDI has increased, treatment selections have become based on disease severity. The following algorithm illustrates severity-based treatment decisions²¹:

Treatment recommendations for a first or second episode of CDI within 6 months²¹

Preventing CDI in the healthcare setting¹

Several strategies have been proposed for preventing the spread of CDI in acute care hospitals and long-term care facilities for the elderly. The key points include:

• Assessment of the appropriateness of antimicrobial use and maintenance of surveillance of use in the facility
• Putting CDI patients in private rooms
• Wearing gloves for contact with infected patients
• Using disposable, single-use thermometers and dedicated care equipment, such as stethoscopes and otoscopes
• Observing proper hand cleaning procedures on entry and exit from patient rooms
• Performing environmental cleaning with sporicidal agents, such as bleach
• Initiating an alert system so that lab personnel can inform the appropriate infection control staff immediately when a C. diff test is positive
• Education of healthcare professionals and hospital staff about CDI

Patients with asymptomatic carriage of C. diff should not be isolated and should not be treated for CDI, even if they have a positive toxin test.¹

View a presentation on Clostridium difficile and infection control in the healthcare setting