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Management of Clostridium difficile Infection in Inflammatory Bowel Disease CPU Patient Companion

Clinical practice updates are developed under the guidance of the AGA Institute Clinical Practice Update Committee and provide expert review to synthesize the existing evidence on the management of Clostridium difficile infection in patients with underlying IBD. The evidence is a summation of relevant scientific publications, expert opinion statements and current practice guidelines. The review is a summary of expert opinion in the field without a formal systematic review of evidence.

AGA Clinical Practice Update: Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute.The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

  • Having Clostridium difficile, C. diff, infection and inflammatory bowel disease, or IBD, at the same time is more serious than having either condition alone.
    • Patients with both C. diff and IBD usually need to be hospitalized for more days than those with IBD alone or C. diff alone.
    • Some drugs used to treat C. diff infection are less likely to work on patients with both C. diff and IBD.
    • Patients with IBD are more likely to have a C. diff infection come back after being treated. The infection may also be more serious.
      • An IBD patient with a C. diff infection is four times more likely to die than a patient with IBD alone.
  • Symptoms of C. diff are similar to the symptoms of an IBD flare-up. People with IBD who experience flare-up symptoms should see their doctor immediately to rule out a possible C. diff infection. To do this, the doctor takes a sample of stool to test for the C. diff bacteria.
  • Because of their increased risks, a person with IBD and should be treated differently for a C. diff infection than someone without IBD.
    • To treat a C. diff infection in a person with IBD, the doctor should consider stopping or lowering the dosage of any antibiotics the patient is already taking that is not specifically directed at the C. diff.
    • Vancomycin, a type of antibiotic that works against C. diff, should be given to IBD patients with a C. diff infection. Another antibiotic called fidaxomicin may also be given to IBD patients with a C. diff infection.
      • Using vancomycin instead of other drug options for C. diff can reduce the need for surgery, reduce the need to be hospitalized more than once, and cut time spent in the hospital by one-half.
      • Use of fidaxomicin has also shown to be beneficial, with the majority of patients experiencing an improvement in their diarrhea.
    • If a C. diff infection does not improve after a few days on antibiotics, an underlying IBD flare-up may be to blame.
  • To treat a possible flare-up, the doctor may consider starting the patient on an immune-suppressing drug, such as a steroid, in addition to the antibiotics being used to treat the C. diff.
  • These immune-suppressing drugs may increase the risk of making the C. diff infection worse. Patients who are put on immune-suppressing drugs during a C. diff infection should be watched closely to make sure their symptoms do not get more serious.
    • IBD patients are more likely to have C. diff return (or recur) after being treated. In fact, up to 40% of patients with IBD and C. diff will need to be treated more than once.

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