Clostridium difficile–associated Diarrhea: Brief Review and Update of Medical Management

In the past decade, the epidemiology and treatment of Clostridium difficile–associated diarrhea (CDAD) have significantly changed. C. difficile remains the most important cause of healthcare-associated diarrhea and is increasingly important as a community pathogen. The strains of C. difficile with hypervirulent BI-NAP1-027 and nonBI-NAP1-027 have been reported for after the use of nearly all systemic antibacterial agents worldwide, and strain with BI-NAP1-027 has been responsible for more severe cases of disease. The decreased effectiveness of metronidazole relative to vancomycin in the treatment of CDAD has been demonstrated. Areas of controversy still exist about the best treatment plans, despite the increasing quantity of available data in the literature. Here we review progress in antimicrobial therapy and review currently available nonantimicrobial strategies for CDAD management. The new approval agent, fidaxomicin, has the major benefit to treat CDAD, and has become the therapy of choice for recurrent CDAD. (J Intern Med Taiwan 2013; 24: 309-316)