1887

Abstract

Vancomycin and metronidazole have been used for treating associated disease (CDAD) for the past 25 years, but approximately 20 % of patients develop recurrent disease. The increasing incidence of nosocomial outbreaks, cases of recurrent CDAD and other complications (toxic megacolon, ileus, sepsis) has fuelled the search for different types of treatments. As the understanding of the pathogenesis of this disease has matured, newer treatment strategies that take advantage of these mechanisms have been developed. This review will describe such treatments and examine the evidence for each strategy.

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2005-02-01
2024-04-16
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References

  1. American Society of Health-System Pharmacists; 1998; ASHP therapeutic position statement on the preferential use of metronidazole for the treatment of Clostridium difficile -associated disease. Am J Health-Syst Pharm 55:1407–1411
    [Google Scholar]
  2. Apisarnthanarak A., Razavi B., Mundy L. M. 2002; Adjunctive intracolonic vancomycin for severe Clostridium difficile colitis: case series and review of the literature. Clin Infect Dis 35:690–696 [CrossRef]
    [Google Scholar]
  3. Ariano R. E., Zhanel G. G., Harding G. K. M. 1990; The role of anion-exchange resins in the treatment of antibiotic-associated pseudomembranous colitis. Can Med Assoc J 142:1049–1051
    [Google Scholar]
  4. Barbut F., Richard A., Hamadi K., Chomette V., Burghoffer B., Petit J. C. 2000; Epidemiology of recurrences or reinfections of Clostridium difficile -associated diarrhea. J Clin Microbiol 38:2386–2388
    [Google Scholar]
  5. Beales I. L. P. 2002; Intravenous immunoglobulin for recurrent Clostridium difficile diarrhoea. Gut 51:456– 456 [CrossRef]
    [Google Scholar]
  6. Beloosesky Y., Grosman B., Marmelstein V., Grinblat J. 2000; Convulsions induced by metronidazole treatment for Clostridium difficile- associated disease in chronic renal failure. Am J Med Sci 319:338–339 [CrossRef]
    [Google Scholar]
  7. Bender B. S., Bennett R. G., Laughon B., Greenough W. B., Gaydoes C., Sears S. D., Forman M. S., Bartlett J. G. 1986; Is Clostridium difficile endemic in chronic-care facilities?. Lancet 2:11–13
    [Google Scholar]
  8. Bennett R. G., Gorbach S. L., Goldin R., Chang T. 1996; Treatment of relapsing Clostridium difficile diarrhea with Lactobacillus GG. Nutr Today 31:S35–S38 [CrossRef]
    [Google Scholar]
  9. Berrington A., Borriello P., Brazier J. & 9 other authors; 2004; National Clostridium difficile Standards Group: report to the Department of Health. J Hosp Infect 56 Suppl 1:1–38
    [Google Scholar]
  10. Biller J. A., Katz A. J., Flores A. F., Buie T. M., Gorbach S. L. 1995; Treatment of recurrent Clostridium difficile colitis with Lactobacillus GG. J Pediatr Gastroenterol Nutr 21:224–226 [CrossRef]
    [Google Scholar]
  11. Bolton R. P., Culsaw M. A. 1986; Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic-associated colitis due to Clostridium difficile . Gut 27:1169–1172 [CrossRef]
    [Google Scholar]
  12. Borrelio S. P., Hammes W. P., Holzapfel W., Marteau P., Schrezenmeir J., Vaara M., Valtonen V. 2003; Safety of probiotics that contain lactobacilli or bifidobacteria. Clin Infect Dis 36:775–780 [CrossRef]
    [Google Scholar]
  13. Bowden T. A., Mansberger A. R., Lykins L. E. 1981; Pseudomembraneous enterocolitis: mechanism for restoring floral homeostasis. Am Surg 47:178–183
    [Google Scholar]
  14. Bradbury A. W., Barrett S. 1997; Surgical aspects of Clostridium difficile colitis. Br J Surg 84:150–159 [CrossRef]
    [Google Scholar]
  15. Brown E. B., Talbot G. H., Axelrod P., Provencher M., Hoegg C. 1990; Risk factors for Clostridium difficile toxin-associated diarrhea. Infect Control Hosp Epidemiol 11:283–290 [CrossRef]
    [Google Scholar]
  16. Buggy B. P., Fekety R., Silva J. Jr 1987; Therapy of relapsing Clostridium difficile -associated diarrhea and colitis with the combination of vancomycin and rifampin. J Clin Gastroenterol 9:155–159 [CrossRef]
    [Google Scholar]
  17. Burdon D. W. 1982; Clostridium difficile : the epidemiology and prevention of hospital-acquired infection. Infection 10:203–204 [CrossRef]
    [Google Scholar]
  18. Castagliuolo I., LaMont J. T., Nikulasson S. T., Pothoulakis C. 1996; Saccharomyces boulardii protease inhibits Clostridium difficile toxin A effects in the rat ileum. Infect Immun 64:5225–5232
    [Google Scholar]
  19. Clabots C. R., Johnson S., Olson M. M., Peterson L. R., Gerding D. N. 1992; Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 166:561–567 [CrossRef]
    [Google Scholar]
  20. Davidson D., Peppe J., Louie T. 2004; A phase 2 study of the toxin binding polymer Tolevamer in patients with Clostridium difficile -associated diarrhea. In First International Clostridium difficile Symposium, Slovenia. 5–8 May 2004
    [Google Scholar]
  21. de Lalla F., Nicolin R., Rinaldi E., Scarpellini P., Rigoli R., Manfrin V., Tramarin A. 1992; Prospective study of oral teicoplanin versus oral vancomycin for therapy of pseudomembranous colitis and Clostridium difficile -associated diarrhea. Antimicrob Agents Chemother 36:2192–2196 [CrossRef]
    [Google Scholar]
  22. Delmee M., Vandercam B., Avesani V., Michaux J. L. 1987; Epidemiology and prevention of Clostridium difficile infections in a leukemia unit. Eur J Clin Microbiol 6:623–627 [CrossRef]
    [Google Scholar]
  23. Donskey C. J. 2004; The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 39:219–226 [CrossRef]
    [Google Scholar]
  24. Dudley M. N., McLaughlin J. C., Carrington G., Frick J., Nightingale C. H., Quintiliani R. 1986; Oral bacitracin vs vancomycin therapy for Clostridium difficile -associated diarrhea.A randomized double-blind trial. Arch Intern Med 146:1101–1104 [CrossRef]
    [Google Scholar]
  25. Fekety R. 1997; Guidelines for the diagnosis and management of Clostridium difficile -associated diarrhea and colitis. Am J Gastroenterol 92:739–750
    [Google Scholar]
  26. Fekety R., Silva J., Kauffman C., Buggy B., Deery H. G. 1989; Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. Am J Med 86:15–19
    [Google Scholar]
  27. Fekety R., McFarland L. V., Surawicz C. M., Greenberg R. N., Elmer G. W., Mulligan M. E. 1997; Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis 24:324–333 [CrossRef]
    [Google Scholar]
  28. Feldman R. J., Kallich M., Weinstein M. P. 1995; Bacteremia due to Clostridium difficile : case report and review of extraintestinal Clostridium difficile infections. Clin Infect Dis 20:1560–1562 [CrossRef]
    [Google Scholar]
  29. Fernandez A., Anand G., Friedenberg F. 2004; Factors associated with failure of metronidazole in Clostridium difficile -associated disease. J Clin Gastroenterol 38:414–418 [CrossRef]
    [Google Scholar]
  30. Friedenberg F., Fernandez A., Kaul V., Niami P., Levine G. M. 2001; Intravenous metronidazole for the treatment of Clostridium difficile colitis. Dis Colon Rectum 44:1176–1180 [CrossRef]
    [Google Scholar]
  31. Garbutt J. M., Littenberg B., Evanoff M. A., Sahm D., Mundy L. M. 1999; Enteric carriage of vancomycin-resistant Enterococcus faecium in patients tested for Clostridium difficile . Infect Control Hosp Epidemiol 20:664–670 [CrossRef]
    [Google Scholar]
  32. Gerding D. N. 2000; Treatment of Clostridium difficile -associated diarrhea and colitis. Curr Top Microbiol Immunol 250:127–139
    [Google Scholar]
  33. Gerding D. N., Johnson S., Peterson L. R., Mulligan M. E., Silva J. 1995; Clostridium difficile -associated diarrhea and colitis. Infect Control Hosp Epidemiol 16:459–477 [CrossRef]
    [Google Scholar]
  34. Gorbach S. L., Chang T., Goldin B. 1987; Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet 2:1519
    [Google Scholar]
  35. Gravisse J., Bernaud G., Hanau-Bercot B., Raskine L., Riahi J., Gaillard J. L., Sandon-Le-Pors M. J. 2003; Clostridium difficile brain empyema after prolonged intestinal carriage. J Clin Microbiol 41:509–511 [CrossRef]
    [Google Scholar]
  36. Hassett J., Meyers S., McFarland L. V., Mulligan M. E. 1995; Recurrent Clostridium difficile infection in a patient with selective IgG1 deficiency treated with intravenous immune globulin and Saccharomyces boulardii . Clin Infect Dis 20:S266–S228 [CrossRef]
    [Google Scholar]
  37. Heerze L. D., Kelm M. A., Talbot J. A., Armstrong G. D. 1994; Oligosaccharide sequences attached to an inert support (SYNSORB) as potential therapy for antibiotic-associated diarrhea and pseudomembranous colitis. J Infect Dis 169:1291–1296 [CrossRef]
    [Google Scholar]
  38. Hennequin C., Kauffmann-Lacroix C., Jobert A., Viard J. P., Ricour C., Jacquemin J. L., Berche P. 2000; Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis 19:16–20 [CrossRef]
    [Google Scholar]
  39. Jarvis W. R. 1998; Epidemiology, appropriateness, and cost of vancomycin use. Clin Infect Dis 26:1200–1203 [CrossRef]
    [Google Scholar]
  40. Johnson S., Adelmann A., Clabots C. R., Peterson L. R., Gerding D. N. 1989; Recurrences of Clostridium difficile diarrhea not caused by the original infecting organism. J Infect Dis 159:340–343 [CrossRef]
    [Google Scholar]
  41. Johnson S., Clabots C. R., Linn F. V., Olson M. M., Peterson L. R., Gerding D. N. 1990; Nosocomial Clostridium difficile colonization and disease. Lancet 336:97–100 [CrossRef]
    [Google Scholar]
  42. Johnson S., Homann S. R., Bettin K. M., Quick J. N., Clabots C. R., Peterson L. R., Gerding D. N. 1992; Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metrodindazole.A randomized, placebo-controlled trial. Ann Intern Med 117:297–302 [CrossRef]
    [Google Scholar]
  43. Johnson S., Sanchez J. L., Gerding D. N. 2000; Metronidazole resistance in Clostridium difficile . Clin Infect Dis 31:625–626 [CrossRef]
    [Google Scholar]
  44. Kato H., Kato N., Watanabe K., Ueno K., Sakata Y., Fujita K. 1996; Relapses or reinfections: analysis of a case of Clostridium difficile associated colitis by two typing systems. Curr Microbiol 33:220–223 [CrossRef]
    [Google Scholar]
  45. Keighley M. R. B., Burdon D. W., Arabi Y. & 7 other authors; 1978; Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea. Br Med J 2:1667–1669 [CrossRef]
    [Google Scholar]
  46. Kerr R. B., McLaughlin D. I., Sonnenberg L. W. 1990; Control of Clostridium difficile colitis outbreak by treating asymptomatic carriers with metronidazole. Am J Infect Control 18:332–335 [CrossRef]
    [Google Scholar]
  47. Khan R., Cheesbrough J. 2003; Impact of changes in antibiotic policy on Clostridium difficile -associated diarrhoea (CDAD) over a five-year period in a district general hospital. J Hosp Infect 54:104–108 [CrossRef]
    [Google Scholar]
  48. Kyne L., Merry C., O'Connell B., Kelly A., Keane C., O'Neill D. 1999; Factors associated with prolonged symptoms and severe disease due to Clostridium difficile . Age Ageing 28:107–113 [CrossRef]
    [Google Scholar]
  49. Kyne L., Warny M., Qamar A., Kelly C. P. 2001; Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhea. Lancet 357:189–193 [CrossRef]
    [Google Scholar]
  50. Kyne L., Hamel M. B., Polavaram R., Kelly C. P. 2002; Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile . Clin Infect Dis 34:346–353 [CrossRef]
    [Google Scholar]
  51. Lam S., Singer C., Tucci V., Morthland V. H., Pfaller M. A., Isenberg H. D. 1995; The challenge of vancomycin-resistant enterococci: a clinical and epidemiologic study. Am J Infect Control 23:170–180 [CrossRef]
    [Google Scholar]
  52. Leung D. Y., Kelly C. P., Boguniewicz M., Pothoulakis C., LaMont J. T., Flores A. 1991; Treatment with intravenously administered gamma globulin of chronic relapsing colitis inducted by Clostridium difficile toxin. J Pediatr 118:633–637 [CrossRef]
    [Google Scholar]
  53. Levett P. N. 1991; Time-dependent killing of Clostridium difficile by metronidazole and vancomycin. J Antimicrob Chemother 27:55–62 [CrossRef]
    [Google Scholar]
  54. Liacouras C. A., Piccoli D. A. 1996; Whole-bowel irrigation as an adjunct to the treatment of chronic, relapsing Clostridium difficile colitis. J Clin Gastroenterol 22:186–189 [CrossRef]
    [Google Scholar]
  55. Lowenkron S. E., Waxner J., Khullar P., Ilowite J. S., Niederman M. S., Fein A. M. 1996; Clostridium difficile infection as a cause of severe sepsis. Intensive Care Med 22:990–994 [CrossRef]
    [Google Scholar]
  56. Ludlam H., Brown N., Sule O., Redpath C., Coni N., Owen G. 1999; An antibiotic policy associated with reduced risk of Clostridium difficile -associated diarrhoea. Age Ageing 28:578–580 [CrossRef]
    [Google Scholar]
  57. Mayfield J. L., Leet T., Miller J., Mundy L. M. 2000; Environmental control to reduce transmission of Clostridium difficile . Clin Infect Dis 31:995–1000 [CrossRef]
    [Google Scholar]
  58. McFarland L. V. 2000a; A review of the evidence of health claims for biotherapeutic agents. Microb Ecol Health Dis 12:65–76 [CrossRef]
    [Google Scholar]
  59. McFarland L. V. 2000b; Normal flora: diversity and functions. Microb Ecol Health Dis 12:193–207 [CrossRef]
    [Google Scholar]
  60. McFarland L. V., Mulligan M. E., Kwok R. Y. Y., Stamm W. E. 1989; Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320:204–210 [CrossRef]
    [Google Scholar]
  61. McFarland L. V., Surawicz C. M., Stamm W. E. 1990; Risk factors for Clostridium difficile carriage and C.difficile -associated diarrhea in a cohort of hospitalized patients. J Infect Dis 162:678–684 [CrossRef]
    [Google Scholar]
  62. McFarland L. V., Surawicz C. M., Greenberg R. N. & 10 other authors; 1994; A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 271:1913–1918 [CrossRef]
    [Google Scholar]
  63. McFarland L. V., Surawicz C. M., Rubin M., Fekety R., Elmer G. W., Greenberg R. N. 1999; Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 20:43–50 [CrossRef]
    [Google Scholar]
  64. McFarland L. V., Brandmarker S. A., Guandalini S. 2000; Pediatric Clostridium difficile : a phantom menace or clinical reality?. J Pediatr Gastroenterol Nutr 31:220–231 [CrossRef]
    [Google Scholar]
  65. McFarland L. V., Elmer G. W., Surawicz C. M. 2002; Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 97:1769–1775 [CrossRef]
    [Google Scholar]
  66. Mogg G. A., George R. H., Youngs D., Johnson M., Thompson H., Burdon D. W., Keighley M. R. B. 1982; Randomized controlled trial of colestipol in antibiotic-associated colitis. Br J Surg 69:137–139 [CrossRef]
    [Google Scholar]
  67. Nair S., Yadav D., Corpuz M., Pitchumoni C. S. 1998; Clostridium difficile colitis: factors influencing treatment failure and relapse – a prospective evaluation. Am J Gastroenterol 93:1873–1876
    [Google Scholar]
  68. Nomura K., Matsumoto Y., Yoshida N. & 7 other authors; 2004; Successful treatment with rifampin for fulminant antibiotics-associated colitis in a patient with non-Hodgkin's lymphoma. World J Gastroenterol 10:765–766
    [Google Scholar]
  69. Olson M. M., Shanholtzer C. J., Lee J. T. Jr, Gerding D. N. 1994; Ten years of prospective Clostridium difficile -associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol 15:371–381 [CrossRef]
    [Google Scholar]
  70. Pantosti A., Luzzi I., Cardines R., Gianfrilli P. 1985; Comparison of the in vitro activities of teicoplanin and vancomycin against Clostridium difficile and their interactions with cholestryramine. Antimicrob Agents Chemother 28:847–848 [CrossRef]
    [Google Scholar]
  71. Pear S. M., Williamson T. H., Bettin K. M., Gerding D. N., Galgiani J. N. 1994; Decrease in nosocomial Clostridium difficile -associated diarrhea by restricting clindamycin use. Ann Intern Med 120:272–277 [CrossRef]
    [Google Scholar]
  72. Pelaez T., Alcalá L., Alonso R., Rodriguez-Creixems M., Garcia-Lechuz J., Bouza E. 2002; Reassessment of Clostridium difficile susceptibility to metronidazole and vancomycin. Antimicrob Agents Chemother 46:1647–1650 [CrossRef]
    [Google Scholar]
  73. Persky S. E., Brandt L. J. 2000; Treatment of recurrent Clostridium difficile -associated diarrhea by administration of donated stool directly through a colonoscope. Am J Gastroenterol 95:3283–3285
    [Google Scholar]
  74. Pochapin M. 2000; The effect of probiotics on Clostridium difficile diarrhea. Am J Gastroenterol 95:S11–S13 [CrossRef]
    [Google Scholar]
  75. Pron B., Merckx J., Touzet P., Ferroni A., Poyart C., Berche P., Gaillard J. L. 1995; Chronic septic arthritis and osteomyelitis in a prosthetic knee joint due to Clostridium difficile . Eur J Clin Microbiol Infect Dis 14:599–601 [CrossRef]
    [Google Scholar]
  76. Pruksananonda P., Powell K. R. 1989; Multiple relapses of Clostridium difficile -associated diarrhea responding to an extended course of cholestryamine. Pediatr Infect Dis J 8:175–178
    [Google Scholar]
  77. Riley T. V., Bowman R. A., Carroll S. M. 1983; Diarrhoea associated with Clostridium difficile in a hospital population. Med J Aust 1:166–169
    [Google Scholar]
  78. Rupnik M., Grabnar M., Geric B. 2003; Binary toxin producing Clostridium difficile strains. Anaerobe 9:289–294 [CrossRef]
    [Google Scholar]
  79. Salcedo J., Keates S., Pothoulakis C., Warny M., Castagliuolo I., LaMont J. T., Kelly C. P. 1997; Intravenous immunoglobulin therapy for severe Clostridium difficile colitis. Gut 41:366–370 [CrossRef]
    [Google Scholar]
  80. Sanchez J. L., Gerding D. N., Olson M. M., Johnson S. 1999; Metronidazole susceptibility in Clostridium difficile isolates recovered from cases of C.difficile -associated disease treatment failures and successes. Anaerobe 5:201–204 [CrossRef]
    [Google Scholar]
  81. Schwan A., Sjolin S., Trottestam U., Aronsson B. 1984; Relapsing Clostridium difficile enterocolitis cured by rectal infusion of normal faeces. Scand J Infect Dis 16:211–215 [CrossRef]
    [Google Scholar]
  82. Shek F. W., Stacey B. S. F., Rendell J., Hellier M. D., Hanson P. J. V. 2000; The rise of Clostridium difficile : the effect of length of stay, patient age and antibiotic use. J Hosp Infect 45:235–237 [CrossRef]
    [Google Scholar]
  83. Shim J. K., Johnson S., Samore M. H., Bliss D. Z., Gerding D. M. 1998; Primary symptomless colonization by Clostridium difficile and decreased risk of subsequent diarrhoea. Lancet 351:633–636 [CrossRef]
    [Google Scholar]
  84. Surawicz C. M., McFarland L. V., Greenberg R. N. & 8 other authors; 2000; The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii . Clin Infect Dis 31:1012–1017 [CrossRef]
    [Google Scholar]
  85. Swedish CDAD Study Group 1994; Treatment of Clostridium difficile -associated diarrhea and colitis with an oral preparation of teicoplanin; a dose finding study. Scand J Infect Dis 26:309–316 [CrossRef]
    [Google Scholar]
  86. Tang-Feldman Y., Mayo S., Silva J., Cohen S. H. 2003; Molecular analysis of Clostridium difficile strains isolated from 18 cases of recurrent Clostridium difficile -associated diarrhea. J Clin Microbiol 41:3413–3414 [CrossRef]
    [Google Scholar]
  87. Taylor N. S., Bartlett J. G. 1980; Binding of Clostridium difficile cytotoxin and vancomycin by anion-exchange resins. J Infect Dis 141:92–97 [CrossRef]
    [Google Scholar]
  88. Teasley D. G., Gerding D. N., Olson M. M., Peterson L. R., Gebhard R. L., Schwartz M. J., Lee J. T. Jr 1983; Prospective randomised trial of metronidazole versus vancomycin for Clostridium difficile -associated diarrhoea and colitis. Lancet 2:1043–1046
    [Google Scholar]
  89. Tedesco F. J., Gordon D., Fortson W. C. 1985; Approach to patients with multiple relapses of antibiotic-associated pseudomembranous colitis. Am J Gastroenterol 80:867–868
    [Google Scholar]
  90. Thomas C., Stevenson M., Williamson D. J., Riley T. V. 2002; Clostridium difficile -associated diarrhea: epidemiological data from Western Australia associated with a modified antibiotic policy. Clin Infect Dis 35:1457–1462 [CrossRef]
    [Google Scholar]
  91. Thorig L., de Groot N., Hensgens C. M. H. 2001; Bovine hyperimmune whey protein concentrate with specific biological activity as a replacement ingredient. Innov Food Technol December 57–60 http://www.innovfoodtech.com
    [Google Scholar]
  92. Trudel J. L., Deschenes M., Mayrand S., Barkun A. N. 1995; Toxic megacolon complicating pseudomembranous colitis. Dis Colon Rectum 38:1033–1038 [CrossRef]
    [Google Scholar]
  93. Tvede M., Rask-Madsen J. 1989; Bacteriotherapy for chronic relapsing Clostridium difficile diarrhoea in six patients. Lancet 1:1156–1160
    [Google Scholar]
  94. Valiquette L., Low D. E., Pepin J., McGeer A. 2004; Clostridium difficile infection in hospitals: a brewing storm. Can Med Assoc J 171:27–29 [CrossRef]
    [Google Scholar]
  95. van Dissel J. T., de Groot N., Hensgens C. M. H., Numan S., Kuijper E. J., Veldkamp P., van 't Wout J. 2005; Bovine antibody-enriched whey to aid in the prevention of a relapse of Clostridium difficile-associated diarrhoea: preclinical and preliminary clinical data. J Med Microbiol 54:197–205 [CrossRef]
    [Google Scholar]
  96. Warny M., Vaerman J., Avesani V., Delmee M. 1994; Human antibody response to Clostridium difficile toxin A in relation to clinical course of infection. Infect Immun 62:384–389
    [Google Scholar]
  97. Wenisch C., Parschalk B., Hasenhündl M., Hirschl A. M., Graninger W. 1996; Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile -associated diarrhea. Clin Infect Dis 22:813–818 [CrossRef]
    [Google Scholar]
  98. Wilcox M. H. 2004; Descriptive study of intravenous immunoglobulin for the treatment of recurrent Clostridium difficile diarrhoea. J Antimicrob Chemother 53:882–884 [CrossRef]
    [Google Scholar]
  99. Wilcox M. H., Fawley W. N., Settle C. D., Davidson A. 1998; Recurrence of symptoms in Clostridium difficile infection – relapse or reinfection?. J Hosp Infect 38:93–100 [CrossRef]
    [Google Scholar]
  100. Wullt M., Odenholt I. 2004; A double-blind randomized controlled trial of fusidic acid and metronidazole for treatment of an initial episode of Clostridium difficile -associated diarrhea. J Antimicrob Chemother 54:211–216 [CrossRef]
    [Google Scholar]
  101. Wullt M., Hagslatt M. L., Odenholt I. 2003; Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile- associated diarrhoea: a double-blind, placebo-controlled trial. Scand J Infect Dis 35:365–367 [CrossRef]
    [Google Scholar]
  102. Wüst J., Sullivan N. M., Hardegger U., Wilkins T. D. 1982; Investigation of an outbreak of antibiotic-associated colitis by various typing methods. J Clin Microbiol 16:1096–1101
    [Google Scholar]
  103. Young G. P., Ward P. B., Bayley N., Gordon D., Higgins G., Trapani J. A., McDonald M. I., Labrooy J., Hecker R. 1985; Antibiotic-associated colitis due to Clostridium difficile : double-blind comparison of vancomycin with bacitracin. Gastroenterology 89:1038–1045
    [Google Scholar]
  104. Zimmerman R. K. 1991; Risk factors for Clostridium difficile cytotoxin-positive diarrhea after control for horizontal transmission. Infect Control Hosp Epidemiol 12:96–100 [CrossRef]
    [Google Scholar]
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