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British Medical Bulletin Advance Access published online on June 8, 2009
British Medical Bulletin, doi:10.1093/bmb/ldp021
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

The management of Clostridium difficile infection

O. Martin Williams and Robert C. Spencer*

Health Protection Agency Regional Laboratory South West, Level 8, Queens Building, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK

* Correspondence to: R. C. Spencer, Health Protection Agency Regional Laboratory South West, Level 8, Queens Building, Bristol Royal Infirmary Marlborough Street, Bristol BS2 8HW, UK. E-mail: robert.spencer{at}uhbristol.nhs.uk

Introduction/background: Clostridium difficile is the commonest cause of nosocomial diarrhoea. The epidemiology and clinical phenotype of the disease has dramatically changed with the global emergence of a virulent strain of C. difficile.

Source: This review was compiled using data from individual studies and review articles identified from PubMed. The retrieved articles were also examined for additional references.

Areas of agreement: Appropriate and timely infection control measures are required to control C. difficile infection (CDI) in the hospital environment, and either oral metronidazole or vancomycin remains the mainstay of treatment depending on the severity of infection.

Areas of controversy: The optimal method for diagnosing CDI remains unclear, as does the best therapeutic strategy for the management of multiple relapses.

Growing points/areas timely for developing research: Studies of new antimicrobial agents with activity against C. difficile are required to improve the management of multiply relapsing disease. The use of novel therapeutic approaches that do not require antimicrobials requires urgent research, including the use of immunological or vaccine-based regimen, bacteriotherapy or C. difficile-specific bacteriophages.

Keywords: Clostridium difficile • risk factors • treatment

Accepted for publication May 6, 2009.


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