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This clinically oriented document is meant to complement the Infectious Diseases Society of America's 2018 guideline on Clostridioides difficile infections (NEJM JW Infect Dis May 2018 and Clin Infect Dis 2018; 66:e1). The authors rate each recommendation as strong or conditional, and they grade the quality of supporting evidence as high, moderate, or low.
A two-step diagnostic testing algorithm is favored: Start with a sensitive test for C. difficile infection (CDI), and when results are positive, perform specific testing for toxin.
Oral vancomycin or fidaxomicin generally is favored for treating patients with nonsevere CDI, but metronidazole i…