Treatment of recurrent Clostridium difficile infection: A systematic review

Infection

Volumn 42, Issue 1, 2014, Pages 43-59

  O'Horo, J C ^a   Jindai, K ^b   Kunzer, B ^b   Safdar, N ^b,c  

^a MAYO CLINIC   (United States)

^b UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH   (United States)

^c WILLIAM S MIDDLETON MEMORIAL VETERANS HOSPITAL   (United States)

Author keywords

Antibiotic; Clostridium difficile; Fecal bacteriotherapy; Immunoglobulin; Recurrent clostridium difficile; Treatment

Indexed keywords

FIDAXOMICIN; IMMUNOGLOBULIN; METRONIDAZOLE; NITAZOXANIDE; PROBIOTIC AGENT; RIFAMPICIN; VANCOMYCIN;

ADJUVANT THERAPY; ANTIBIOTIC THERAPY; CLOSTRIDIUM DIFFICILE; CLOSTRIDIUM DIFFICILE INFECTION; CRITICALLY ILL PATIENT; DRUG EFFICACY; FECAL BACTERIOTHERAPY; HUMAN; INTESTINE FLORA; META ANALYSIS; PSEUDOMEMBRANOUS COLITIS; RECURRENT INFECTION; RETREATMENT; REVIEW; SACCHAROMYCES BOULARDII; SYSTEMATIC REVIEW; THERAPY; TREATMENT DURATION; TREATMENT FAILURE;

ANTI-INFECTIVE AGENTS; BIOLOGICAL THERAPY; CLOSTRIDIUM DIFFICILE; CLOSTRIDIUM INFECTIONS; DIARRHEA; DRUG THERAPY; HUMANS; METRONIDAZOLE; RECURRENCE; TREATMENT OUTCOME; VANCOMYCIN;

EID: 84898542092     PISSN: 03008126     EISSN: 14390973     Source Type: Journal    
DOI: 10.1007/s15010-013-0496-x     Document Type: Review

References (105)

1. Lo Vecchio A, Zacur GM. Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol. 2012;28:1-9.
2. Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366:1079-84. doi:10.1016/S0140-6736(05)67420-X. (Pubitemid 41338761)
3. McDonald LC, Killgore GE, Thompson A, Owens RC Jr, Kazakova SV, Sambol SP, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353:2433-41. doi:10.1056/NEJMoa051590. (Pubitemid 41770164)
4. Pepin J, Alary M-E, Valiquette L, Raiche E, Ruel J, Fulop K, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40:1591-7. (Pubitemid 40720808)
5. Wenisch JM, Schmid D, Tucek G, Kuo HW, Allerberger F, Michl V, et al. A prospective cohort study on hospital mortality due to Clostridium difficile infection. Infection. 2012;40:479-84. doi:10.1007/s15010-012-0258-1.
6. Razavi B, Apisarnthanarak A, Mundy LM. Clostridium difficile: emergence of hypervirulence and fluoroquinolone resistance. Infection. 2007;35:300-7. doi:10.1007/s15010-007-6113-0. (Pubitemid 47502344)
7. Johnson S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect. 2009;58:403-10.
8. Ghantoji SS, Sail K, Lairson DR, DuPont HL, Garey KW. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect. 2010;74:309-18.
9. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31:431-55. doi:10.1086/651706.
10. Moher D, Altman DG, Liberati A, Tetzlaff J. PRISMA statement. Epidemiology. 2011;22:128; author reply 128. doi:10.1097/EDE.0b013e3181fe7825.
11. Mezoff E, Mann EA, Hart KW, Lindsell CJ, Cohen MB. Clostridium difficile infection and treatment in the pediatric inflammatory bowel disease population. J Pediatr Gastroenterol Nutr. 2011;52:437-41.
12. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377-84. (Pubitemid 28438523)
13. Tedesco FJ, Gordon D, Fortson WC. Approach to patients with multiple relapses of antibiotic-associated pseudomembranous colitis. Am J Gastroenterol. 1985;80:867-8. (Pubitemid 16233533)
14. Shetler K, Nieuwenhuis R, Wren SM, Triadafilopoulos G. Decompressive colonoscopy with intracolonic vancomycin administration for the treatment of severe pseudomembranous colitis. Surg Endosc. 2001;15:653-9. doi:10.1007/s004640080104. (Pubitemid 32622608)
15. McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol. 2002;97:1769-75. (Pubitemid 34761404)
16. Pépin J, Routhier S, Gagnon S, Brazeau I. Management and outcomes of a first recurrence of Clostridium difficile-associated disease in Quebec, Canada. Clin Infect Dis. 2006;42:758-64. doi:10.1086/501126. (Pubitemid 43363928)
17. Surawicz CM, McFarland LV, Greenberg RN, Rubin M, Fekety R, Mulligan ME, et al. The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis. 2000;31:1012-7. doi:10.1086/318130. (Pubitemid 32299362)
18. Basu PP, Shah NJ, Krishnaswamy N, Korapati R, Tang C, Pacana T. Sequential use of nitazoxanide (NTZ) as a salvage therapy in patient with recurrent mild to moderate Clostridium difficile infection (CDI): a prospective, open-label, randomized clinical trial. Am J Gastroenterol. 2010;105:S142
19. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364:422-31. doi:10.1056/NEJMoa0910812.
20. Cornely OA, Miller MA, Louie TJ, Crook DW, Gorbach SL. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55:S154-61. doi:10.1093/cid/cis462.
21. Musher DM, Logan N, Bressler AM, Johnson DP, Rossignol J-F. Nitazoxanide versus vancomycin in Clostridium difficile infection: a randomized, double-blind study. Clin Infect Dis. 2009;48:e41-6.
22. van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368:407-15. doi:10.1056/NEJMoa1205037.
23. Drekonja DM, Butler M, MacDonald R, Bliss D, Filice GA, Rector TS, et al. Comparative effectiveness of Clostridium difficile treatments: a systematic review. Ann Intern Med. 2011;155:839-47.
24. Cohen MD. Quality assurance: potential use for the newly described exposure index in clinical practice. J Am Coll Radiol. 2010;7:748-9. doi:10.1016/j.jacr.2010.04.008.
25. Mattila E, Anttila VJ, Broas M, Marttila H, Poukka P, Kuusisto K, et al. A randomized, double-blind study comparing Clostridium difficile immune whey and metronidazole for recurrent Clostridium difficile-associated diarrhoea: efficacy and safety data of a prematurely interrupted trial. Scand J Infect Dis. 2008;40:702-8. doi:10.1080/00365540801964960.
26. Wullt M, Hagslätt MLJ, Odenholt I. Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile-associated diarrhoea: a double-blind, placebo-controlled trial. Scand J Infect Dis. 2003;35:365-7. doi:10.1080/00365540310010985. (Pubitemid 37038627)
27. Baines SD, O'Connor R, Freeman J, Fawley WN, Harmanus C, Mastrantonio P, et al. Emergence of reduced susceptibility to metronidazole in Clostridium difficile. J Antimicrob Chemother. 2008;62:1046-52.
28. Musher DM, Logan N, Mehendiratta V, Melgarejo NA, Garud S, Hamill RJ. Clostridium difficile colitis that fails conventional metronidazole therapy: response to nitazoxanide. J Antimicrob Chemother. 2007;59:705-10. doi:10.1093/jac/dkl553. (Pubitemid 47073405)
29. Buggy BP, Fekety R, Silva J Jr. Therapy of relapsing Clostridium difficile-associated diarrhea and colitis with the combination of vancomycin and rifampin. J Clin Gastroenterol. 1987;9:155-9. (Pubitemid 17046362)
30. Berman AL. Efficacy of rifaximin and vancomycin combination therapy in a patient with refractory Clostridium difficile -associated diarrhea. J Clin Gastroenterol. 2007;41:932-3. doi:10.1097/01.mcg.0000225685.37465.e7. (Pubitemid 350307082)
31. Johnson S, Schriever C, Galang M, Kelly CP, Gerding DN. Interruption of recurrent Clostridium difficile-associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clin Infect Dis. 2007;44:846-8. doi:10.1086/511870. (Pubitemid 46365312)
32. Garey KW, Jiang ZD, Bellard A, Dupont HL. Rifaximin in treatment of recurrent Clostridium difficile-associated diarrhea: an uncontrolled pilot study. J Clin Gastroenterol. 2009;43:91-3. doi:10.1097/MCG.0b013e31814a4e97.
33. Johnson S, Schriever C, Patel U, Patel T, Hecht DW, Gerding DN. Rifaximin Redux: treatment of recurrent Clostridium difficile infections with rifaximin immediately post-vancomycin treatment. Anaerobe. 2009;15:290-1.
34. Neff G, Zacharias V, Kaiser TE, Gaddis A, Kemmer N. Rifaximin for the treatment of recurrent Clostridium difficile infection after liver transplantation: a case series. Liver Transpl. 2010;16:960-3. doi:10.1002/lt.22092.
35. Basu PP, Dinani A, Rayapudi K, Pacana T, Shah NJ, Hampole H, et al. Rifaximin therapy for metronidazole-unresponsive Clostridium difficile infection: a prospective pilot trial. Ther Adv Gastroenterol. 2010;3:221-5. doi:10.1177/1756283X10372985.
36. Musher DM, Logan N, Hamill RJ, Dupont HL, Lentnek A, Gupta A, et al. Nitazoxanide for the treatment of Clostridium difficile colitis. Clin Infect Dis. 2006;43:421-7. doi:10.1086/506351. (Pubitemid 44157148)
37. Louie TJ, Cannon K, Byrne B, Emery J, Ward L, Eyben M, et al. Fidaxomicin preserves the intestinal microbiome during and after treatment of Clostridium difficile infection (CDI) and reduces both toxin reexpression and recurrence of CDI. Clin Infect Dis. 2012;55:S132-42. doi:10.1093/cid/cis338.
38. Venugopal AA, Johnson S. Fidaxomicin: a novel macrocyclic antibiotic approved for treatment of Clostridium difficile infection. Clin Infect Dis. 2012;54:568-74.
39. Lowy I, Molrine DC, Leav BA, Blair BM, Baxter R, Gerding DN, et al. Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med. 2010;362:197-205. doi:10.1056/NEJMoa0907635.
40. Leung DY, Kelly CP, Boguniewicz M, Pothoulakis C, LaMont JT, Flores A. Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J Pediatr. 1991;118:633-7.
41. Salcedo J, Keates S, Pothoulakis C, Warny M, Castagliuolo I, LaMont JT, et al. Intravenous immunoglobulin therapy for severe Clostridium difficile colitis. Gut. 1997;41:366-70. (Pubitemid 27428197)
42. Beales IL. Intravenous immunoglobulin for recurrent Clostridium difficile diarrhoea. Gut. 2002;51:456.
43. Wilcox MH. Descriptive study of intravenous immunoglobulin for the treatment of recurrent Clostridium difficile diarrhoea. J Antimicrob Chemother. 2004;53:882-4. doi:10.1093/jac/dkh176. (Pubitemid 38660298)
44. McPherson S, Rees CJ, Ellis R, Soo S, Panter SJ. Intravenous immunoglobulin for the treatment of severe, refractory, and recurrent Clostridium difficile diarrhea. Dis Colon Rectum. 2006;49:640-5. doi:10.1007/s10350-006-0511-8. (Pubitemid 43723812)
45. Jiang ZD, Garey KW, Price M, Graham G, Okhuysen P, Dao-Tran T, et al. Association of interleukin-8 polymorphism and immunoglobulin G anti-toxin A in patients with Clostridium difficile-associated diarrhea. Clin Gastroenterol Hepatol. 2007;5:964-8. doi:10.1016/j.cgh.2007.04.018. (Pubitemid 47127029)
46. Aslam S, Hamill RJ, Musher DM. Treatment of Clostridium difficile-associated disease: old therapies and new strategies. Lancet Infect Dis. 2005;5:549-57. doi:10.1016/S1473-3099(05)70215-2. (Pubitemid 41196754)
47. O'Horo J, Safdar N. The role of immunoglobulin for the treatment of Clostridium difficile infection: a systematic review. Int J Infect Dis. 2009;13:663-7. doi:10.1016/j.ijid.2008.11.012.
48. Yazdankhah S, Midtvedt T, Narvhus J, Berstad A, Lassen J, Halvorsen R. The use of probiotics for critically ill patients in hospitals. Microb Ecol Health Dis. 2009;21:114-21. doi:10.3109/08910600903495046.
49. O'Hara AM, Shanahan F. The gut flora as a forgotten organ. EMBO Rep. 2006;7:688-93. doi:10.1038/sj.embor.7400731. (Pubitemid 43986264)
50. Arumugam M, Raes J, Pelletier E, Le Paslier D, Yamada T, Mende DR, et al. Enterotypes of the human gut microbiome. Nature. 2011;473:174-80. doi:10.1038/nature09944.
51. D'Souza AL, Rajkumar C, Cooke J, Bulpitt CJ. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ. 2002;324:1361.
52. McFarland LV, Surawicz CM, Greenberg RN, Fekety R, Elmer GW, Moyer KA, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA. 1994;271:1913-8. (Pubitemid 24177098)
53. Elmer GW, McFarland LV, Surawicz CM, Danko L, Greenberg RN. Behaviour of Saccharomyces boulardii in recurrent Clostridium difficile disease patients. Aliment Pharmacol Ther. 1999;13:1663-8. (Pubitemid 30009085)
54. Surawicz CM, McFarland LV, Elmer G, Chinn J. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol. 1989;84:1285-7. (Pubitemid 19264721)
55. Gorbach SL, Chang TW, Goldin B. Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet. 1987;2:1519. (Pubitemid 18013761)
56. Biller JA, Katz AJ, Flores AF, Buie TM, Gorbach SL. Treatment of recurrent Clostridium difficile colitis with Lactobacillus GG. J Pediatr Gastroenterol Nutr. 1995;21:224-6.
57. Seal D, Borriello SP, Barclay F, Welch A, Piper M, Bonnycastle M. Treatment of relapsing Clostridium difficile diarrhoea by administration of a non-toxigenic strain. Eur J Clin Microbiol. 1987;6:51-3. (Pubitemid 17034620)
58. Miller M. The fascination with probiotics for Clostridium difficile infection: lack of evidence for prophylactic or therapeutic efficacy. Anaerobe. 2009;15:281-4.
59. Eiseman B, Silen W, Bascom GS, Kauvar AJ. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery. 1958;44:854-9.
60. Bakken JS, Borody T, Brandt LJ, Brill JV, Demarco DC, Franzos MA, et al. Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol. 2011;9:1044-9.
61. Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis. 2011;53:994-1002.
62. Postigo R, Kim JH. Colonoscopic versus nasogastric fecal transplantation for the treatment of Clostridium difficile infection: a review and pooled analysis. Infection. 2012;40:643-8. doi:10.1007/s15010-012-0307-9.
63. Maire F. La transplantation fécale: Un traitement d'avenir de la colite à Clostridium difficile? [Fecal transplantation: new therapy for recurrent Clostridium difficile infection?]. Hépato-Gastro. 2012;19:285-8. doi:10.1684/hpg.2012.0710.
64. Polák P, Freibergerová M, Juránková J, Kocourková H, Mikešová L, Svačina R, et al. Prvnízkušenosti s fekální bakterioterapií v léčbě relabující pseudomembranó zní kolitidy způsobené Clostridium difficile [First experiences with faecal bacteriotherapy in the treatment of relapsing pseudomembranous colitis due to Clostridium difficile]. Klin Mikrobiol Infekc Lek. 2011;17:214-7.
65. Schwan A, Sjölin S, Trottestam U, Aronsson B. Relapsing Clostridium difficile enterocolitis cured by rectal infusion of normal faeces. Scand J Infect Dis. 1984;16:211-5. (Pubitemid 14104160)
66. Persky SE, Brandt LJ. Treatment of recurrent Clostridium difficile-associated diarrhea by administration of donated stool directly through a colonoscope. Am J Gastroenterol. 2000;95:3283-5. doi:10.1111/j.1572- 0241.2000.03302.x.
67. Hellemans R, Naegels S, Holvoet J. Fecal transplantation for recurrent Clostridium difficile colitis, an underused treatment modality. Acta Gastroenterol Belg. 2009;72:269-70.
68. Khoruts A, Dicksved J, Jansson JK, Sadowsky MJ. Changes in the composition of the humanfecal microbiome after bacteriotherapy for recurrent Clostridium difficile-associated diarrhea. J Clin Gastroenterol. 2010;44:354-60. doi:10.1097/MCG.0b013e3181c87e02.
69. Russell G, Kaplan J, Ferraro M, Michelow IC. Fecal bacteriotherapy for relapsing Clostridium difficile infection in a child: a proposed treatment protocol. Pediatrics 2010;126:e239-42. doi:10.1542/peds.2009-3363.
70. Fløtterød O, Hopen G. Refractory Clostridium difficile infection. Untraditional treatment of antibiotic-induced colitis. Tidsskr Nor Laegeforen. 1991;111:1364-5.
71. Härkönen N. Uusiutuneen pseudomembranoottisen koliitin hoito ulosteensiirrolla [Recurrent pseudomembranous colitis treated with the donor feces]. Duodecim. 1996;112:1803-4.
72. Tvede M, Rask-Madsen J. Bacteriotherapy for chronic relapsing Clostridium difficile diarrhoea in six patients. Lancet. 1989;1:1156-60. (Pubitemid 19138849)
73. Paterson DL, Iredell J, Whitby M. Putting back the bugs: bacterial treatment relieves chronic diarrhoea. Med J Aust. 1994;160:232-3. (Pubitemid 24057461)
74. Faust G, Langelier D, Haddad H, Menard DB. Treatment of recurrent pseudomembranous colitis with stool transplantation: report of six cases. Can J Gastroenterol. 2002;16:A43.
75. Aas J, Gessert CE, Bakken JS. Recurrent Clostridium difficile colitis: case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clin Infect Dis. 2003;36:580-5. (Pubitemid 36259562)
76. Jorup-Rönström C, Håkanson A, Persson AK, Midtvedt T, Norin E. Feceskultur framgångsrik terapi vid Clostridium difficile-diarré. Lakartidningen. 2006;103:3603-5. (Pubitemid 44820006)
77. Wettstein A, Borody T, Leis S, Chongnan J, Torres M, Hindler JF. Fecal bacteriotherapy - an effective treatment for relapsing symptomatic Clostridium difficile infection. In: 15th United European Gastroenterology Week 2007; France 2007.
78. Louie T, Louie MR, Krulicki W, Byrne B, Ward L. Home-based fecal flora infusion to arrest multiply-recurrent Clostridium difficile infection. In: 48th Interscience Conference on Antimicrobial Agents and Chemotherapy; Arlington, VA: Infectious Disease Society of America; 2008.
79. MacConnachie AA, Fox R, Kennedy DR, Seaton RA. Faecal transplant for recurrent Clostridium difficile-associated diarrhoea: a UK case series. QJM. 2009;102:781-4. doi:10.1093/qjmed/hcp118.
80. Garborg K, Waagsbø B, Stallemo A, Matre J, Sundøy A. Results of faecal donor instillation therapy for recurrent Clostridium difficile-associated diarrhoea. Scand J Infect Dis. 2010;42:857-61. doi:10.3109/00365548.2010.499541.
81. Kelly C, de Leon L. Successful treatment of recurrent Clostridium difficile infection with donor stool administered at colonoscopy: a case series. Am J Gastroenterol. 2010;105:S135; abstract 366
82. Mellow MH, Kanatzar A. Colonoscopic fecal bacteriotherapy in the treatment of recurrent Clostridium difficile infection - results and follow-up. Am J Gastroenterol. 2010;105:S135
83. Miller CB, Dellon E, Isaacs K, Gangarosa L. Fecal bacteriotherapy via colonoscopy as rescue therapy for refractory and recurrent Clostridium difficile-associated diarrhea. Am J Gastroenterol. 2010;105:S323
84. Rohlke F, Surawicz CM, Stollman N. Fecal flora reconstitution for recurrent Clostridium difficile infection: results and methodology. J Clin Gastroenterol. 2010;44:567-70.
85. Silverman MS, Davis I, Pillai DR. Success of self-administered home fecal transplantation for chronic Clostridium difficile infection. Clin Gastroenterol Hepatol. 2010;8:471-3. doi:10.1016/j.cgh.2010.01.007.
86. Yoon SS, Brandt LJ. Treatment of refractory/recurrent C. difficile-associated disease by donated stool transplanted via colonoscopy: a case series of 12 patients. J Clin Gastroenterol. 2010;44:562-6.
87. Brandt LJ, Aroniadis OC, Mellow M, Kanatzar A, Kelly C, Park T, et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012;107:1079-87. doi:10.1038/ajg.2012.60.
88. Hamilton MJ, Weingarden AR, Sadowsky MJ, Khoruts A. Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012;107:761-7. doi:10.1038/ajg.2011. 482.
89. Jorup-Rönström C, Håkanson A, Sandell S, Edvinsson O, Midtvedt T, Persson AK, et al. Fecal transplant against relapsing Clostridium difficile-associated diarrhea in 32 patients. Scand J Gastroenterol. 2012;47:548-52. doi:10.3109/00365521.2012.672587.
90. Kassam Z, Hundal R, Marshall JK, Lee CH. Fecal transplant via retention enema for refractory or recurrent Clostridium difficile infection. Arch Intern Med. 2012;172:191-3. doi:10.1001/archinte.172.2.191.
91. Kelly CR, de Leon L, Jasutkar N. Fecal microbiota transplantation for relapsing Clostridium difficile infection in 26 patients: methodology and results. J Clin Gastroenterol. 2012;46:145-9.
92. Mattila E, Uusitalo-Seppälä R, Wuorela M, Lehtola L, Nurmi H, Ristikankare M, et al. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology. 2012;142:490-6.
93. Mellow MH, Kanatzar A. Colonoscopic fecal bacteriotherapy in the treatment of recurrent Clostridium difficile infection-results and follow-up. J Okla State Med Assoc. 2011;104:89-91.
94. Lund-Tønnesen S, Berstad A, Schreiner A, Midtvedt T. Clostridium difficile-assosiert diare behandlet med homolog feces [Clostridium difficile-associated diarrhoea treated with homologous faeces]. Tidsskr Nor Laegeforen. 1998;118:1027-30. (Pubitemid 28135942)
95. Liacouras CA, Piccoli DA. Whole-bowel irrigation as an adjunct to the treatment of chronic, relapsing Clostridium difficile colitis. J Clin Gastroenterol. 1996;22:186-9. (Pubitemid 26118621)
96. Herpers BL, Vlaminckx B, Burkhardt O, Blom H, Biemond-Moeniralam HS, Hornef M, et al. Intravenous tigecycline as adjunctive or alternative therapy for severe refractory Clostridium difficile infection. Clin Infect Dis. 2009;48:1732-5. doi:10.1086/599224.
97. Louie TJ, Peppe J, Watt CK, Johnson D, Mohammed R, Dow G, et al. Tolevamer, a novel nonantibiotic polymer, compared with vancomycin in the treatment of mild to moderately severe Clostridium difficile-associated diarrhea. Clin Infect Dis. 2006;43:411-20. doi:10.1086/506349. (Pubitemid 44157147)
98. Barker RH Jr, Dagher R, Davidson DM, Marquis JK. Review article: tolevamer, a novel toxin-binding polymer: overview of preclinical pharmacology and physicochemical properties. Aliment Pharmacol Ther. 2006;24:1525-34. (Pubitemid 44915200)
99. Dubberke E. Strategies for prevention of Clostridium difficile infection. J Hosp Med. 2012;7:S14-7. doi:10.1002/jhm.1908.
100. Centers for Disease Control and Prevention (CDC). Vital signs: preventing Clostridium difficile infections. MMWR Morb Mortal Wkly Rep. 2012;61:157-62.
101. Tedesco FJ, Barton RW, Alpers DH. Clindamycin-associated colitis. A prospective study. Ann Intern Med. 1974;81:429-33.
102. Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995;16:459-77
103. Hassett J, Meyers S, McFarland L, Mulligan ME. Recurrent Clostridium difficile infection in a patient with selective IgG1 deficiency treated with intravenous immune globulin and Saccharomyces boulardii. Clin Infect Dis. 1995;20:S266-68. doi:10.1093/clinids/20.Supplement-2.S266
104. Murphy C, Vernon M, Cullen M. Intravenous immunoglobulin for resistant Clostridium difficile infection. Age Ageing. 2006;35:85-86. doi:10.1093/ageing/ afi212 (Pubitemid 43124929)
105. Hassoun A, Ibrahim F. Use of intravenous immunoglobulin for the treatment of severe Clostridium difficile colitis. Am J Geriatr Pharmacother. 2007;5:48-51. doi:10.1016/j.amjopharm.2007.03.001 (Pubitemid 47411047)