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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Bhupinder Anand, MD

Many other antibiotics have been used for the treatment of C. diff infection; however, to date only metronidazole (Flagyl) and vancomycin (Vancocin) have been approved.

Rifaximin (Xifaxan), a newer antibiotic, has shown some benefit in reducing the recurrence rate if the drug is given immediately after completion of a course of vancomycin (Vancocin).

Intracolonic vancomycin (placing the antibiotic inside the colon through the rectum) has been studied in cases of refractory C. diff infection, but data showing the benefit of this approach are limited at this time.

Probiotics (such as Lactobacillus, Streptococcus salivarius, and Saccharomyces boulardii) are micro-organisms that are derived from food products, especially dairy products, and are non-infectious. Although these compounds are harmless, they have not been shown to be beneficial either in the treatment or prevention of C. difficile colitis. These drugs are, therefore, not recommended despite their widespread use.

Intravenous Immunoglobulin (IVIG) with C. diff antitoxin has been used in the treatment of recurrent infections, but the results are not better than the standard treatment.

Finally, fecal bacteriotherapy (or fecal enema) has been examined in patients with severe and recurrent disease. This treatment entails the introduction of feces, containing the usual gut bacteria (gut flora) obtained from healthy individuals directly into the colon of the infected patient. This is believed to restore the normal gut flora in the infected person that was altered by the use of antibiotics. While this approach has shown some promise, the data are very limited, and the procedure may be difficult from a practical standpoint.

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