Today, with the development, widespread use, and poor prescribing practices of antibiotics over time, C diff infection rates have increased exponentially.

Originally discovered  in 1935, Clostridioides difficile was identified as the organism responsible  for the majority of cases of antibiotic-associated diarrhoea and life-threatening colitis. C diff is now listed by the Centers for Disease Control and Prevention as being among the top five urgent antibiotic resistance threats in the US,  with recent data reporting 223,900 infections and 12,800 deaths due to C diff in 2017 alone. 

Since the onset of the COVID-19 pandemic in 2019, it is estimated that approximately 72% of COVID-19 patients were treated with broad-spectrum antibiotics, mostly respiratory quinolones, to prevent bacterial co-infections. As such, the number of C diff infections, particularly recurrences, is expected to increase over time. Complicating factors include the overlap of gastrointestinal (GI) associated COVID-19 symptoms with those of C diff disease in co-infected patients, which can present diagnostic challenges resulting in under or misdiagnosis, leading to delayed initiation of appropriate treatment.

While COVID-19 is dominating the infectious disease space, many do not realise that patients with COVID-19 infection are frequently co-infected with bacterial infections (e.g. sepsis, bacterial pneumonia, etc.) that can lead to hospitalisation and the need for antibiotic therapy. An immediate by-product of the COVID-19 pandemic has been an increase in antimicrobial-resistant infections, including C diff. C diff is a pervasive public health concern in elderly, hospitalised patients, and residents of long-term care facilities (LTCFs) who have recently undergone antibiotic therapy.

Medical management of C diff infection typically involves multiple levels of intervention beginning, with fluid and electrolyte repletion as well as discontinuation of any precipitating antibiotic agents. Additional medications are often required in order to reduce the population of spore-forming C diff organisms in the GI tract. Longstanding treatment regimens for C diff have historically involved oral and IV antibiotics including metronidazole and vancomycin. However, emerging resistance (such as with the NAP1/BI/027 strain) has complicated the approach to medication management. Due to substantially reduced efficacy from these proliferating resistant C diff strains, metronidazole was removed from preferred therapy recommendations  in recent clinical practice guidelines.

This blog is a condensed version of European Biopharmaceutical Review, October 2020 edition entitled: “Treatment Options for Clostridiotides Difficile”. To view, please visit

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ICON's Infectious Diseases and Vaccines teams contribute regularly to media and industry conversations in addition to the production of thought leadership content in the form of whitepapers and blogs.

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