Invited Commentary

Commentary on "High Frequency of Nonadherence to Clostridium difficile Treatment Guidelines"

Authors: Paul Froom, MD, MOccH

Abstract

The diagnosis of a Clostrium difficile infection (CDI) is seen usually in hospitalized patients with diarrhea who are most often being treated with antibiotics. CDI is rarely noted in patients with severe abdominal pain without diarrhea. As pointed out in the study by McEllistrem and colleagues in this issue of the Southern Medical Journal,1 recommended treatment is metronidazole for mild CDI and vancomycin for more severe disease. The clinical utility of treatment may include the shortening of the symptomatic period, prevention of severe complications, and prevention of relapses, as well as the spread of infection to other patients. Before implementing consensus guidelines, we need to consider the evidence.

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References

1. McEllistrem MC, McGraw M, Sahud AG, et al. High frequency of nonadherence to Clostridium difficile treatment guidelines. South Med J 2014;107:603-605. 2. Iv EC, Iii EC, Johnson DA. Clinical update for the diagnosis and treatment of Clostridium difficile infection. Review. World J Gastrointest Pharmacol Ther 2014;5:1-26. 3. Loo VG, Bourgault AM, Poirier L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 2011;365:1693-1703. 4. Nelson RL, Kelsey P, Leeman H, et al. Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database Syst Rev 2011;9:CD004610. 5. Zar FA, Bakkanagari SR, Moorthi KM, et al. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007;45:302-307.