New C. Difficile Guidance Recommends Fecal Microbiota Transplantation in Adults with Recurrent Infections

March 5, 2018 | Strategic Insights for Ambulatory Care


​The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America have updated guidelines for treating Clostridium difficile infections, significantly changing the recommendations for adults, and expanding them to include direction on how to best diagnose and treat pediatric patients. The update, published online February 15, 2018, in Clinical Infectious Diseases, recommends adult patients with any type of infection—whether mild or severe, first-time or recurring—adhere to a minimum 10-day course of vancomycin or fidaxomicin instead of metronidazole. Evidence shows fidaxomicin, a newly recommended medication for C. difficile infections, may also reduce repeat episodes in adults with mild to moderate cases, which occur in about 25% of patients. Vancomycin is preferred over metronidazole for pediatric patients with severe infections, while metronidazole is the recommended treatment for children with initial or recurring episodes that are mild to moderate. Fecal microbiota transplantation (FBT) is strongly recommended for adults who have had at least two recurrences of the infection after the use of antibiotics; however, the guidelines advise caution on using FBT in pediatric patients.

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