Antimicrobial therapy of Clostridium difficile-associated diarrhea

Clostridium difficile-associated diarrhea (CDAD) is the most common etiologically defined cause of hospital-acquired diarrhea. Caused by the toxins of certain strains of C difficile, CDAD represents a growing concern, with epidemic outbreaks in some hospitals where very aggressive and difficult-to-treat strains have recently been found. Incidence of CDAD varies ordinarily between 1 to 10 in every 1,000 admissions. Evidence shows that CDAD increases morbidity, lengths of stay, and costs. This article describes the clinical manifestations of CDAD, related risk factors, considerations for confirming CDAD, antimicrobial and nonantimicrobial treatment of CDAD, and issues related to relapses. The article concludes with a discussion of recent epidemic outbreaks involving CDAD.