AGA Expert Review Reframes C difficile Management in IBD

This AGA Clinical Practice Update gives pharmacists 12 actionable Best Practice Advice statements on diagnosing and treating Clostridioides difficile infection in inflammatory bowel disease, emphasizing fidaxomicin, avoidance of metronidazole, and microbiome-based therapy for recurrence.

fidaxomicinvancomycinmetronidazoleClostridioides difficileinflammatory bowel diseaseulcerative colitisCrohn's diseasefecal microbiota transplantationRBLVOSmicrobiome therapyprobioticsoral vancomycin prophylaxisAGA clinical practice updateguideline Guideline: IDSA

Background Information

CDI poses higher risks for IBD patients, complicating management strategies.

Managing Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) is crucial due to higher risks and complications compared to non-IBD patients. Best practice advises include using fidaxomicin for CDI, considering microbiome-based therapies for recurrent CDI, and continuing IBD treatment during CDI management. Clear guidance is provided despite lacking formal evidence ratings; practical advice is applicable to real-world clinical decisions. Optimal CDI management in IBD patients requires integrating antibiotic choice with ongoing IBD treatment.

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Authors: Khanna S, Allegretti JR, Hashash JG, Feuerstadt P

Citation: Khanna S, Allegretti JR, Hashash JG, et al. AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Inflammatory Bowel Disease: Expert Review. Gastroenterology. 2026;171(1):184-192. doi:10.1053/j.gastro.2026.03.008

Article Links: PubMed · Journal / DOI

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