Treatment

Treatments are used only if a person has signs or symptoms of infection. People who carry the bacteria — but are not sick — are not treated.

Antibiotics

If C. difficile infection is related to an antibiotic you're taking, your doctor will likely discontinue use of that drug. In many cases, however, an antibiotic treatment is critical for treating another infectious condition. Your doctor may prescribe a different antibiotic that is less likely to contribute to diarrhea related to C. difficile infection.

Antibiotics are the mainstay to treat C. difficile infection. Commonly used antibiotics include:

• Vancomycin (Vancocin HCL, Firvanq)
• Fidaxomicin (Dificid)

Metronidazole (Flagyl) may be used in combination with vancomycin to treat serious C. difficile infection.

Surgery

Surgery to remove the diseased portion of the colon may be necessary in some cases, including:

• Severe pain
• Organ failure
• Toxic megacolon
• Inflammation of the lining of the abdominal wall

Treatment for recurrent infection

Approximately 25% of people treated for C. difficile infection get sick again, either because the initial infection never went away or because they've been reinfected with a different strain of the bacteria. The risk increases with each C. difficile infection episode and exceeds 50% after three or more infections.

Your risk of recurrence is higher if you:

• Are older than 65
• Are taking other antibiotics for a different condition while being treated with antibiotics for C. difficile infection
• Have a severe underlying medical disorder, such as chronic kidney failure, inflammatory bowel disease or chronic liver disease

Treatment for recurrent disease may include the following strategies.

• Antibiotics. Antibiotic therapy for recurrent infections may involve one or more courses of a medication. The drugs are usually different from the type of antibiotic used previously. The effectiveness of antibiotic therapy declines with each subsequent recurrence.
• Antibody-based therapy. A therapy, known as bezlotoxumab (Zinplava), is a human antibody against the C. difficile toxin B and has been shown to reduce the risk of recurrent C. difficile infection in those at a high risk of recurrence.

• Fecal microbiota transplant (FMT). FMT is an emerging treatment for multiple recurrent C. difficile infection that has been studied in clinical trials. The U.S. Food and Drug Administration has not approved FMT but allows the use of FMT for C. difficile infection as an experimental procedure. You need to sign an informed consent about the benefits and risks of the experimental procedure. FMT is also called a stool transplant or an intestinal microbiota transplant.

  FMT restores healthy intestinal bacteria by placing another person's (donor's) stool in your colon with specialized tubes inserted through your rectum. Donors are screened for medical conditions, their blood is tested for infections, and stools are carefully screened for parasites, viruses and other infectious bacteria before being used for FMT.

  Research has shown that FMT done one or more times has a success rate higher than 85% for treating recurrent C. difficile infections.

• Probiotics. Probiotics are supplements or foods that contain microorganisms intended to maintain or improve the "good" bacteria in the body. The role of these products in C. difficile infection is controversial. Research hasn't consistently shown that currently available products are helpful in preventing or treating infection with C. difficile. Advanced probiotics are currently being studied for their potential use in the treatment or prevention of C. difficile infection but aren't currently available.