Clostridium difficile-associated disease: update and focus on non-antibiotic strategies.

Clostridium difficile-associated disease (CDAD) is a problem of especially the frail elderly. Changes in virulence of prevalent strains in the early years of the new century saw mortality and morbidity increase from historical levels. This article explores non-antibiotic strategies including the use of probiotics. A number of avenues of ongoing research appear to have potential future clinical application. Evidence exists linking acid-inhibiting drugs to an increased risk of CDAD, and the adjunctive use of Saccharomyces boulardii and infection control measures in the treatment of CDAD.