eISSN: 2449-8580
ISSN: 1734-3402
Family Medicine & Primary Care Review
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SCImago Journal & Country Rank
3/2024
vol. 26
 
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abstract:
Review paper

Recommendations for the management of Clostridioides difficile infection in adults and comparison with updated ACG, ESCMID and IDSA/SHEA guidelines

Mateusz Piotr Baran
1
,
Jarosław Drobnik
2
,
Mária Belovičová
3, 4, 5
,
Štefánia Moricová
6
,
Piotr Pobrotyn
7

  1. Individual Specialist Medical Practice Mateusz Baran, Wroclaw, Poland
  2. Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
  3. Faculty of Public Health Studies, Department of Preventive and Clinical Medicine, Slovak Medical University, Bratislava, Slovakia
  4. Internal Clinic for Liver Disease Diagnosis and Treatment, Remedium s.r.o., Bardejov Spa, Slovakia
  5. Slovak Society of Practical Obesitology (SSPO), Bardejov, Slovakia
  6. Faculty of Public Health Studies SZU, Institute of Occupational Health Service, Bratislava, Slovakia
  7. Remedial Specialistic Clinic “Pulsantis Sp. z o.o.”, Wroclaw, Poland
Family Medicine & Primary Care Review 2024; 26(3): 352–356
Online publish date: 2024/09/30
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Clostridioides difficile infection is the most common cause of antibiotic-associated diarrhea. IDSA/SHEA, ESCMID and ACG updated the clinical practice guidelines for CDI in 2021. This paper is an attempt to summarize these guidelines. The clinical presentation of Clostridioides difficile infection is varied, ranging from oligosymptomatic forms to generalized infection with sepsis. It is recommended that testing be performed only on patients with an active infection that is characterized by unexplained new-onset diarrhea. A two-stage testing algorithm should be used. The first step should be GDH or NAAT. If an initial test is positive, EIA should be performed. The first line of drugs for the treatment of Clostridioides difficile infection are vancomycin and fidaxomicin. Metronidazole should only be used if other treatment options are not available. Bezlotoxumab is a humanized monoclonal antibody that binds to and neutralizes the Clostridioides difficile toxin B. The IDSA/SHEA and ESCMID guidelines suggest adding bezlotoxumab to antibiotic therapy in patients with recurrent Clostridioides difficile infection who have had a previous episode within the last six months. Fecal microbiota transplantation (FMT) as a treatment option for second and subsequent recurrences of CDI only in patients who have been treated with the correct therapy in previous episodes. Subtotal resection of the colon with preservation of the rectum is currently considered the gold standard in the surgical treatment of Clostridioides difficile infection. According to ESCMID and ACG, vancomycin is the drug of choice for Clostridioides difficile infection in pregnancy.
keywords:

Clostridium infections, Clostridioides difficile, toxic megacolon

 
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