Letter to the Editor: Treating and Preventing Clostridium difficile Infection in Long-Term Care Facilities
The treatment recommendations in the December 2018 Annals of Long-Term Care tip sheet article “Treating and Preventing Clostridium difficile Infection in Long-Term Care Facilities”1 are based on a guideline published in 2010.2
However, this guideline was updated in 2017 and there have been changes in the treatment recommendations.3 The specific treatment changes are as follows:
In terms of initial treatment of Clostridium difficile (C diff) infection (CDI), metronidazole is no longer recommended. The guideline now recommends vancomycin or fidaxomicin as initial treatment.
The guideline now recommends that a first recurrence should be treated with vancomycin as a tapered and pulsed regimen or fidaxomicin for 10 days whether or not metronidazole was used initially.
The guideline also has changed the terminology for severity of CDI. The previous terminology categorized infection into mild/moderate and severe cases. The latest terminology is nonsevere, severe, and
fulminant with definitions for each category.
Providers and clinicians using or referencing the tip sheet should adjust their diagnosis and treatment of C diff based on the above guidelines.
Joseph M Mylotte, MD, FIDSA, FSHEA, FACP
Professor of Medicine Emeritus
School of Medicine and Biomedical Sciences
State University of New York
Buffalo, NY
References
1. Little M. Treating and preventing clostridium difficile infection in long-term care facilities. Ann Longterm Care. 2018;26(7):25-29. doi:10.25270/altc.2018.10.00043
2. Cohen SH, Gerding DN, Johnson S, Kelly CP, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-455.
3. McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2017 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Clin Infect Dis. 2018;66(7):e1-e48.
