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Antimicrobial agents that may induce Clostridioides (formerly Clostridium) difficile diarrhea and colitis

Antimicrobial agents that may induce Clostridioides (formerly Clostridium) difficile diarrhea and colitis
Frequently associated Occasionally associated Rarely associated
  • Fluoroquinolones
  • Clindamycin
  • Penicillins and combinations (broad spectrum)
  • Cephalosporins (2nd/3rd/4th generation)*
  • Carbapenems
  • Macrolides
  • Penicillins (narrow spectrum)
  • Cephalosporins (1st generation)
  • Trimethoprim-sulfamethoxazole
  • Sulfonamides
  • Aminoglycosides
  • Tetracyclines
  • Tigecycline
  • Chloramphenicol
  • Metronidazole
  • Vancomycin
* Use of 1 to 2 doses of a first-generation cephalosporin for surgical antibiotic prophylaxis does not confer significant risk for C. difficile infection.
Data from:
  1. McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018; 66:987.
  2. Slimings C, Riley TV. Antibiotics and healthcare facility-associated Clostridioides difficile infection: systematic review and meta-analysis: 2020 update. J Antimicrob Chemother 2021:dkab091.
  3. Vardakas KZ, Trigkidis KK, Boukouvala E, Falagas ME. Clostridium difficile infection following systemic antibiotic administration in randomised controlled trials: a systematic review and meta-analysis. Int J Antimicrob Agents 2016; 48:1.
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