PulmCCM - September 28, 2018 - By Kenny Jon-Emile
...In general I find the IDSA guidelines to be of excellent quality with fair and reasonable assessment of the evidence. I find their approach to diagnosis – which is inherently Bayesian – to be an admirable synthesis of the current literature. It seems prudent to set forth institutional guidelines for C. difficile testing bearing in mind the inherent imperfection of recipe-based medicine – especially in the immunocompromised. Equally important is to know the diagnostic characteristics of the bioassays employed in one’s hospital.
The previous guidelines also relied upon risk assessment to guide treatment of C. difficile. While the 2018 approach follows suit, treatment is now the same for mild and severe disease. This follows – since publication of the last guidelines – the observed superiority of vancomycin in all disease severities; accordingly, oral metronidazole should rarely be considered..."