3. Brief review of treatment options
Treatment guidelines for CDI have been published by the Infectious
Diseases Society of America and the European Society of
Clinical Microbiology and Infectious Diseases [46,47]. Paradoxically,
the mainstay of therapy is still based on antimicrobials that disrupt
significantly the gut microbiota placing the patients at risk of
relapse [48e50]. The first-line treatment in primary and first
recurrence of CDI is metronidazole for mild disease whilst oral
vancomycin is preferred for severe infection due to its proven superior
efficacy [46,47]. Vancomycin use is recommended for
treatment of multiple recurrences, usually administered as a pulsed
or tapered regimen [51].
The global C. difficile epidemic of the last two decades and the
increasing reports of metronidazole failures and CDI recurrence
after vancomycin treatment [52,53] have fuelled research into
novel therapeutic approaches.
Among novel antibiotic options, fidaxomicin, a narrowspectrum
macrocyclic antibiotic, has recently been approved for
the treatment of CDI. In two randomized controlled trials