Treatment of Clostridioides (Clostridium) difficile infection

Ann Med. Feb-Mar 2020;52(1-2):12-20. doi: 10.1080/07853890.2019.1701703. Epub 2019 Dec 13.


Clostridioides (formerly: Clostridium) difficile infection (CDI) is a major cause of diarrhoea for inpatients as well as outpatients. Usually, CDI is healthcare-associated but the number of community-acquired infections is increasing. CDI is generally associated with changes in the normal intestinal microbiota caused by administration of antibiotics. Elderly and immunocompromised patients are at greater risk for CDI and CDI recurrence. Recently, the treatment options of CDI have undergone major changes: current recommendations speak against using metronidazole for primary CDI, fidaxomicin and bezlotoxumab have been added to the treatment armamentarium and microbial replacement therapies have emerged. Several other therapies are undergoing clinical trials. In this article, we review current treatment guidelines, present the most recent data on the options to treat CDI and glance towards future developments.KEY MESSAGESThe cornerstones for the treatment of CDI are vancomycin and fidaxomicin. Metronidazole should be used only in mild-to-moderate disease in younger patients who have no or only few risk factors for recurrence.In recurrent CDI, bezlotoxumab infusion (a monoclonal antibody against C. difficile toxin B) may be considered as an adjunctive therapeutic strategy in addition to the standard care provided to patients with several risk factors for recurrence.Faecal microbiota transplantation (FMT) should be offered to patients with frequently recurring CDI.

Keywords: C. difficile diarrhoea; Clostridioides difficile; Clostridium difficile; faecal microbiota transplantation.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Monoclonal / therapeutic use
  • Broadly Neutralizing Antibodies / therapeutic use
  • Clostridium Infections / mortality
  • Clostridium Infections / therapy*
  • Fecal Microbiota Transplantation
  • Fidaxomicin / therapeutic use
  • Humans
  • Practice Guidelines as Topic
  • Recurrence
  • Risk Factors
  • Severity of Illness Index
  • Vancomycin / therapeutic use


  • Anti-Bacterial Agents
  • Antibodies, Monoclonal
  • Broadly Neutralizing Antibodies
  • bezlotoxumab
  • Vancomycin
  • Fidaxomicin