It’s time to rethink your approach to &lt;i&gt;C diff&lt;/i&gt; infection

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doi:10.12788/jfp.0021

Applied Evidence

It’s time to rethink your approach to C diff infection

J Fam Pract. 2020 July;69(6):293-300 | 10.12788/jfp.0021

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References

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In preparing for stool transplantation, patients should be treated with standard doses of oral vancomycin or fidaxomicin for 3 days before the procedure to suppress intestinal C difficile, and the last dose of antibiotics should be given 12 to 48 hours before the procedure.²⁶ Bowel lavage with polyethylene glycol is recommended, regardless of whether stool is delivered via colonoscopy or upper GI route.

Short-term adverse events associated with FMT appear to be minimal; data is lacking for long-term safety outcomes.²⁸ While only recommended currently for cases of recurrent CDI, there is promising data emerging for use of FMT for severe cases, even without recurrence.²⁹

The role of probiotics remains unclear

Probiotics have been explored in numerous trials to determine if they are effective in preventing CDI in patients who have been prescribed antibiotics.¹¹ While no randomized trials have conclusively shown benefit, several meta-analyses have shown that the use of probiotics may result in a 60% to 65% relative risk reduction in CDI incidence.^30,31

One proviso to these meta-analyses is that the incorporated studies have typically included patients at very high risk for CDI, and subanalyses have only found a reduction in CDI incidence when patients are at a very high baseline risk. In addition, there are many differences in probiotic types, formulations, treatment durations, and follow-up. As a result, the IDSA guidelines state that there is “insufficient data at this time” to recommend routine administration of probiotics for either primary or secondary CDI prophylaxis.¹¹

Due to insufficient high-quality data, the IDSA guidelines do not provide a recommendation regarding use as an adjunct treatment option for acute CDI.¹¹ Probiotics should not be routinely used to prevent CDI; however, they may provide benefit if reserved for patients at the highest risk for CDI (eg, history of CDI, prolonged use of broad-spectrum antibiotics, high local incidence).

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