Clostridium Difficile Colitis

Abstract

Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated and nosocomial infectious diarrhea. Presenting as clostridium difficile colitis, it is a significant cause of morbidity and mortality. Metronidazole is regarded as the agent of choice for CDl therapy and also for the first recurrence in most patients with mild to moderate CDI. Vancomycin is recommended as an initial therapy for patients with severe CDI. With recent Food and Drug Administration-approval fidaxomicin is available for clinical use and is as effective as vancomycin with lower relapse rates. Rifaximin and fecal bacteriotherapy are alternative approaches in patients with severe or refractory CDI, before surgical intervention. Antibiotic research is ongoing to add potential new drugs such as teicoplanin, ramoplanin, fusidic acid, nitazoxanide, rifampin, bacitracin to our armamentarium. Role of toxin-binding agents is still questionable. Monoclonal antibody and intravenous immunoglobulin are still investigational therapies that could be promising options. The ongoing challenges in the treatment of CDI include management of recurrence and presence of resistance strains such as NAP1/BI/027, but early recognition of surgical candidates can potentially decrease mortality in CDI.

Detection, Ribotyping and Antimicrobial Resistance Properties of Clostridium difficile Strains Isolated From The Cases of Diarrhea

“…High prevalence of antibiotic resistance in the C. difficile strains of clinical infections cause more severe diseases for longer periods of time (14-16). According to the recent epidemiological studies, C. difficile strains of clinical samples represented a high prevalence of resistance (20-80%) against commonly used antibiotics (14-17).…”

“…High prevalence of antibiotic resistance in the C. difficile strains of clinical infections cause more severe diseases for longer periods of time (14-16). According to the recent epidemiological studies, C. difficile strains of clinical samples represented a high prevalence of resistance (20-80%) against commonly used antibiotics (14-17). Therefore, it is important to know exact antibiotic resistance pattern of C. difficile strains of diarrhea to found the best therapeutic approach for control and even establishment of novel therapeutic ways for treatment of C. difficile -based diarrhea in children.…”

Binaphthyl-1,2,3-triazole peptidomimetics with activity against Clostridium difficile and other pathogenic bacteria

“…2 C. difficile produces potent toxins which cause symptoms such as diarrhea, abdominal pain and pseudomembranous colitis (PMC) upon gastrointestinal infection. [3][4][5] C. difficile infection (CDI) occurs in up to 20% of patients given conventional oral antibiotic therapy due to elimination of the commensal, gastrointestinal microflora. 3,4 High morbidity and up to an 8% mortality rate highlights the seriousness of this disease, with both the severity and incidence increasing due to epidemics of hypervirulent strains.…”

“…3,4 High morbidity and up to an 8% mortality rate highlights the seriousness of this disease, with both the severity and incidence increasing due to epidemics of hypervirulent strains. [3][4][5] Further, the nosocomial nature of the infection and the persistence of C. difficile spores results in a major health problem and a serious financial burden to the healthcare sector (>$1 billion per year in the USA alone). 5 Traditional medications for the treatment of CDI (vancomycin and metronidazole) are inadequate as reinfection occurs in 15-35% of patients.…”

“…3,4 Fidaxomicin was approved by the Food and Drug Administration in 2011 for the treatment of CDI, exhibiting a decrease in recurrence relative to that of vancomycin and metronidazole. 6,7 Potential CDI chemotherapeutics are currently under various stages of development, these include REP3123, 8 nitazoxanide, 9 fusidic acid, 5 teicoplanin, 5,10 LFF571, 11 CB-183 315 12 and cationic nylon-3 polymers. 13 Furthermore, monoclonal antitoxin antibodies are under investigation as potential treatments for CDI recurrence.…”