Increased Clostridium difficile Virulence Demands New Treatment Approach

KEYWORDS:
• ANTI-BACTERIAL AGENTS
• CLOSTRIDIUM DIFFICILE
• DISEASE OUTBREAKS
• DRUG RESISTANCE
• DRUG RESISTANCE, BACTERIAL
• FLUOROQUINOLONES
• METRONIDAZOLE
• SEVERITY OF ILLNESS INDEX
• THERAPEUTICS
• VANCOMYCIN

The rapid spread of a particularly virulent strain of Clostridium difficile has prompted the development of new clinical guidelines that focus on how physicians should tailor treatment based on patients' disease severity.

New recommendations advise that treatment of Clostridium difficile infection should be based on disease severity. A once-uncommon strain has mutated, causing more severe disease.

(Photo credit: Paul Gunning/www.sciencesource.com)

Earlier guidelines, published 15 years ago, suggested that metronidazole and vancomycin were equally effective treatment for patients with C difficile infection. But clinical data that have emerged following recent reports of increased incidence, more severe symptoms, and higher death rates from C difficile demonstrated the need to reexamine existing treatment recommendations.

The new guidelines, compiled by an expert panel from the Society of Healthcare Epidemiology (SHEA) and the Infectious Diseases Society of America, recommend that patients with mild to moderate symptoms receive metronidazole, but that those with severe disease be given oral vancomycin (http://www.journals.uchicago.edu/doi/pdf/10.1086/651706 …