This open access CCJM review of C. diff provides an overview of diagnosis and treatment as well as an update on the new NAP 1 strain. A few tidbits--
Fluoroquinolones appear to be more strongly associated than other antibiotics including clindamycin.
The new NAP 1 strain produces more toxin than old strains and may be responsible for recent trends toward more severe disease.
Antiulcer medications add to the risk for disease.
Recent reports of treatment failures with metronidazole have suggested changed treatment recommendations. This review suggests metronidazole as initial treatment for mild disease with consideration of oral vancomycin as initial treatment for moderate or severe cases.
Clinical progress rather than repeat toxin assays should guide management decisions and surgical consultation is recommended when disease progresses during treatment.
Adjunctive measures such as probiotic therapy, IVIG and agents to bind toxin have garnered interest but are not supported by high level evidence.
Antimotility agents including narcotics should be avoided, as they increase the risk for megacolon.