Treatment of recurrent Clostridium difficile diarrhea

Treatment of recurrent Clostridium difficile-associated diarrhea can be challenging. Once patients develop recurrent disease, further episodes are common and can continue for months or even a year or more. Treatment begins with a repeat standard 10-day course of antibiotics, followed by tapering and/or pulsing of the antibiotic dose. Probiotics can also be useful, particularly the nonpathogenic yeast Saccharomyces boulardii. Stool reconstitution via fecal enemas, colonoscopy, and nasogastric tubes have, been performed to restore normal colonic flora. Additional approaches under investigation, such as vaccination against C. difficile, show encouraging preliminary results.