Doctor, my patient has CDI and should continue to receive antibiotics. The (unresolved) risk of recurrent CDI

• Published in: Revista española de quimioterapia Vol. 32 Suppl 2; no. Suppl 2; pp. 47 - 54
• Main Authors: Castro, I, Tasias, M, Calabuig, E, Salavert, M
• Format: Journal Article
• Language: English
• Published: Spain Sociedad Española de Quimioterapia 01.09.2019
• Subjects: Anti-Bacterial Agents - therapeutic use; Clostridium difficile; Clostridium Infections - drug therapy; Enterocolitis, Pseudomembranous - drug therapy; Humans; Recurrence; Update in Nosocomial Infection
• ISSN: 0214-3429; 1988-9518

Recurrence rate ranges from 12% to 40% of all cases of Clostridium difficile infection (CDI) and proposes an exceptional clinical challenge. Conventionally, treatment options of CDI have been limited to regimes of established antibiotics (eg, pulsed/tapered vancomycin) or "improvised" alternative antibiotics (eg. teicoplanin, tigecycline, nitazoxanide or rifaximin) occasionally even in combination, but faecal microbiota transplantation is emerging as a useful and quite safe alternative. In recent years, promising new strategies have emerged for effective prevention of recurrent CDI (rCDI) including new an-timicrobials (eg, fidaxomicin) and monoclonal antibodies (eg, bezlotoxumab). Despite promising progress in this area, difficulties remain for making the best use of these resources due to uncertainty over patient selection. This positioning review describes the current epidemiology of rCDI, its clinical impact and risk factors, some of the measures used for treating and preventing rCDI, and some of the emerging treatment options. It then describes some of the barriers that need to be overcome.