Clostridium difficile infection rates in the US increased from 30-40 per 100,000 in the mid-1990s to 84 per 100,000 in 2005, and in Britain C. diff became the primary cause of an increasing number of deaths from 499 in 1999 to 3393 in 2006. While metronidazole and vancomycin have been the standard treatments since the 1970s, failure rates for metronidazole increased significantly to 18.2% since 2000. Metronidazole is recommended as the first line treatment for mild cases, but vancomycin should be used for more severe infections. The ultimate goal in treating recurrent C. diff infections is to discontinue all antibiotics

1. Clostridium difficile

2. Incidence and Severity During the mid- and late 1990s, in the US, the incidence was 30 to 40 per 100,000 Incidence increased to 50 per 100,000 in 2001 to 84 per 100,000 in 2005. In Britain C. diff as the primary cause of death increased from 499 in 1999 to 3393 in 2006

3. Metro vs vanc Metronidazole or oral vancomycin have the treatment of choice since the late 1970s Before 2000, failure rates were around 3% for both therapies But since, there have been significant increases in flagyl failure (18.2%) Metronidazole is the first line treatment for mild infections, but vancomycin should be used for severe treatment

6. Management of Recurrence Ultimate goal of treatment is to discontinue all antibiotics Not all patients in whom recurrent diarrhea develops have recurrent C. diff Posinfectious irritable bowel Microscopic colitis Positive toxin with minimal or no symptoms should not prompt treatment Since C. diff is rarely resistant to metronidazole or vancomycin, diarrhea despite therapy should increase suspicion for another etiology