CDI Treatment
Clostridioides (Clostridium) difficile Toolkit for Long-term Care Facilities

Guidance for Long-term Care Facilities

• Whenever possible, other antibiotics should be discontinued. In a small number of patients, diarrhea may go away when other antibiotics are stopped. Proton pump inhibitors (PPI) and antiperistaltic agents should also be avoided for all residents suspected of having or diagnosed with CDI.
• Treatment of primary infection caused by C. difficile is an antibiotic such as metronidazole, vancomycin, or fidaxomicin. While metronidazole is not approved for treating C. difficile infections by the FDA, it has been commonly recommended and used for mild C. difficile infections; however, it should not be used for severe C. difficile infections. Whenever possible, treatment should be given by mouth and continued for a minimum of 10 days.
• One problem with antibiotics used to treat primary C. difficile infection is that the infection returns in about 20 percent of patients. In a small number of these patients, the infection returns over and over and can be quite debilitating. While a first return of a C. difficile infection is usually treated with the same antibiotic used for primary infection, all future infections should be managed with oral vancomycin or fidaxomicin.
• Transplanting stool from a healthy person to the colon of a patient with repeat C. difficile infections has been shown to successfully treat C. difficile. These “fecal transplants” appear to be the most effective method for helping patients with repeat C. difficile infections.  This procedure may not be widely available and its long-term safety has not been established.
• Probiotics are not recommended to prevent primary CDI due to limited data and risk of bloodstream infection. Patients with recurrent CDI may benefit from 500 mg of Saccharomyces boulardii twice a day.