New Australasian Society of Infectious Diseases guidelines for the treatment of Clostridium difficile have been published in the Internal Medicine Journal this month. The guidelines provide management advice for C. difficile in adults and children in both hospital and community settings.The treatment recommendations are:

1. Oral metronidazole 400 mg (child: 10 mg/kg/dose up to 400 mg) three times daily (TDS) for 10 days is recommended as first-line therapy for first episode mild CDI.
2. Oral vancomycin 125 mg (child: 10 mg/kg/dose up to 125 mg) four times daily (QID) is recommended as therapy for first or subsequent CDI recurrence.
3. Oral vancomycin 125 mg (child: 10 mg/kg/dose up to 125 mg) QID is recommended as first-line therapy for severe CDI.
4. Oral fidaxomicin 200 mg twice daily (BD) is a treatment alternative in recurrent CDI (adults). Especially in those with a high risk of relapse
5. Faecal microbiota transplantation (FMT) is a treatment alternative in recurrent CDI for the appropriately selected patient (adults).
6. A rifaximin ‘chaser’ regimen is a treatment alternative in recurrent CDI not amenable to first-line therapies (adults).
7. Oral nitazoxanide: (child 1–3 years) 100 mg; (child 4–11 years) 200 mg; 12 hourly for 7–10 days is a treatment alternative in recurrent CDI (children).

Recommendations 1 and 3 are in line with the Therapeutic Guidelines: Antibiotic but the guideline also takes into account new therapies that are available to treat C. difficile disease. The new guidelines include lots of information on diagnosis of C. difficile infections and antibiotic choice and are an important read for anyone who sees this infection in their practice.

More information is also available in our previous posts on C. difficile testing and faecal microbiota transplantation.