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Clostridium difficile: New Guidelines Confront Hypervirulent Strain


Recurrent C difficile requires pulse vancomycin therapy; fecal microbiota transplant shows promise.

New guidelines on the stratification of severity and subsequent treatment of Clostridium difficile were published in the American Journal of Gastroenterology this spring. The guidelines recommend graduated therapy based on criteria that indicate mild to moderate, severe, or severe and complicated disease.

Here, Dr Christina Surawicz, lead author on the guidelines, highlights changes in recommended diagnostic and treatment approaches.

Hypervirulent Strain

Dr Surawicz is Professor of Medicine in the Division of Gastroenterology and section chief of GI at Harborview Medical Center at the University of Washington School of Medicine. She is the lead author on revised guidelines for the diagnosis, treatment, and prevention of C difficile infections released in April 2013.

Take-home points for primary care

•Polymerase chain reaction assay for toxin B strains will likely replace EIA tests for diagnosis

•Metronidazole remains the choice for mild to moderate disease but may not be adequate for patients with severe or complicated disease who should have initial therapy with vancomycin and sometimes IV metronidazole.

•Recurrent C difficile infection remains difficult to treat; a pulse vancomycin regimen should be tried. Fecal microbiota transplant shows great promise.  

Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108:478-498. Available at :

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