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Kim: Treatment of Refractory or Recurrent Clostridium difficile Infection
Review Article
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(2): 71-78.

Published online: 22 August 2012

DOI: https://doi.org/10.4166/kjg.2012.60.2.71

Treatment of Refractory or Recurrent Clostridium difficile Infection

Sang Woo Kim

Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea.

Correspondence to: Sang Woo Kim, Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, 222 Banpodae-ro, Seocho-gu, Seoul 137-040, Korea. Tel: +82-2-2258-6021, Fax: +82-2-2258-2089, viper@catholic.ac.kr

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The incidence and severity of Clostridium difficile infection (CDI) has increased over the past decades. It is related to the emergence of hypervirulent strains and increased use of antibiotics. The incidence of refractory CDI to standard therapies and the risk for recurrent CDI are also increasing. Current guidelines recommend the first recurrence to be treated with the same agent used for the initial episode. However, data are lacking to support any particular treatment strategy for severe refractory CDI or cases with multiple recurrence. Treatments currently available for CDI are inadequate to prevent recurrence. Widely used method for managing a subsequent recurrence involves tapering followed by pulsed doses of vancomycin. Other potentially effective strategies for recurrent CDI are use of other antibiotics such as fidaxomicin, nitazoxanide, rifaximin, tigecycline, and teicoplanin. There are efforts to recover gut microflora and to optimize immune response to CDI. These include use of probiotics, fecal microbiota transplantation, intravenous immunoglobulin, monoclonal antibodies directed against C. difficile toxins, and active vaccination. However treatment of patients with refractory CDI and those with multiple CDI recurrences is based on limited clinical evidence, and there is an ongoing need for continued research to improve the outcomes these patients.

Keywords: Clostridium difficile infection, Recurrence, Refractory

Figures and Tables

Table 1
Recommendations for the Treatment of Clostridium difficile Infection
kjg-60-71-i001

Quoted from the article of Cohen et al.1

tid, 3 times daily; PO, by mouth; qid, 4 times daily; WBC, white blood cells; IV, intravenous.

Table 2
Strategies for Managing Multiple Clostridium difficile Infection Recurrences
kjg-60-71-i002

Notes

Financial support: None.

Conflict of interest: None.

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