Treatment

Treatment strategies include:

• Stopping the antibiotic or other medication that's thought to be causing your signs and symptoms, if possible. Sometimes, this may be enough to resolve your condition or at least ease signs, such as diarrhea.

• Starting an antibiotic likely to be effective against C. difficile. If you still experience signs and symptoms, your doctor may use a different antibiotic to treat C. difficile. This allows the normal bacteria to grow back, restoring the healthy balance of bacteria in your colon.

  You may be given antibiotics by mouth, through a vein or through a tube inserted through the nose into the stomach (nasogastric tube). Depending on your condition, vancomycin or fidaxomicin (Dificid) is most often used. If these drugs are not available or cannot be tolerated, then metronidazole (Flagyl) may be used.

  For severe disease, your doctor may prescribe vancomycin by mouth combined with intravenous metronidazole or a vancomycin enema.

• Having fecal microbial transplantation (FMT). If your condition is extremely severe or you have had more than one recurrence of the infection, you may be given a transplant of stool (fecal transplant) from a healthy donor to restore the balance of bacteria in your colon. The donor stool may be delivered through a nasogastric tube, inserted into the colon or placed in a capsule you swallow. Doctors may use a combination of antibiotic treatment followed by FMT.

Once you begin treatment for pseudomembranous colitis, signs and symptoms may begin to improve within a few days.

Treating recurring pseudomembranous colitis

The natural occurrence of new, more-aggressive strains of C. difficile, which are more resistant to antibiotics, has made treating pseudomembranous colitis increasingly difficult and recurrences more common. With each recurrence, your chance of having an additional recurrence increases.

Treatment options may include:

• Repeat antibiotics. You may need a second or third round of antibiotics to resolve your condition and may need a longer duration of therapy.

• Surgery. Surgery may be an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall (peritonitis). Surgery has typically involved removing all or part of the colon (total or subtotal colectomy).

  A newer surgery that involves laparoscopically creating a loop of colon and cleaning it (loop ileostomy and colonic lavage) is less invasive and has had positive results.

• Fecal microbial transplantation (FMT). FMT is used to treat recurrent pseudomembranous colitis. You'll receive healthy, cleaned stool in a capsule, nasogastrically or inserted into your colon.
• Bezlotoxumab (Zinplava). The U.S. Food and Drug Administration (FDA) has approved the use of human monoclonal antibody bezlotoxumab to reduce the risk of recurrence of C. difficile infection. Used in combination with antibiotics, bezlotoxumab has been shown to significantly reduce the recurrence of infection. However, cost may be a limiting factor.