Do you recommend, based on current evidence, avoiding antimotility agents in patients with non-fulminant C. difficile infection who have no evidence of ileus?

I generally avoid their use based on the notions that diarrhea may contribute to the elimination of non-invasive GI pathogens and that impairment of intestinal motility could increase the risk of complications, such as toxic megacolon.

The data and recommendations have not progressed beyond the following statement in the most recent (2018) IDSA guideline: “Addition of an antimotility agent such as loperamide as an adjunct to specific antibacterial therapy for CDI may be safe, although no prospective or randomized studies are available.” The 2021 IDSA update did not address the issue.

A retrospective observational study involving “malignant hematology patients” published in 2020 found no increased risk of adverse events in “malignant hematolo...

About 6 years ago, a patient with CDI was still having diarrhea after a few days of treatment. Her attending, my brother-in-law, doubted the efficacy of ID's (my) treatment (po Vanco 125 mg Q3 while awake). While the patient was still having diarrhea, her vital signs, WBC, Cr, and exam continued to improve. I asked the micro lab if they would compare cycle thresholds (Ct) of her stool specimens over time. The leading NAAT C. diff assays are real-time PCR. I wanted to prove to the attending that the patient was indeed responding, although few people heard of Ct prior to COVID-19. As many or most of you know, Ct means the PCR cycle at which the sample's fluorescence crosses a predetermined level. The higher the Ct, the lower the concentration...