Clostridium difficile-associated colitis. Part 2: Therapy and prevention

Clostridium difficile is an anaerobic, Gram positive, spore-forming and toxin-producing bacillus. Colonization of the intestinal tract is facilitated by the administration of various antibiotics, in particular clindamycin, broad spectrum penicillins, fluorochinlones and cephalosporins. The clinical manifestations of C. difficile infections range from an asymptomatic carrier to fulminant disease with toxic megacolon. The cardinal clinical symptom is watery diarrhea accompanied by a pronounced leucocytosis. The most important initial step in the treatment of C. difficile - associated colitis is cessation of the responsible antibiotic. Treatment of non-severe C. difficile infection consists of oral metronidazole and patients with severe C. difficile - associated colitis are treated with oral vancomycin. The recurrence rate is high and a distinction must be made between a true reinfection with a different strain and a relapse of persistent diarrhea.