Primary Antibiotics Associated with Clostridioides difficile Colitis

High-Risk Antibiotics

The World Journal of Emergency Surgery recommends avoiding the use of clindamycin, third-generation cephalosporins, penicillins, and fluoroquinolones due to their strong association with C. difficile infection (CDI) 1, 2
Third-generation cephalosporins are consistently implicated in CDI development across multiple studies and guidelines 1, 2
Penicillins, including ampicillin and amoxicillin, are frequently associated with CDI 2
Fluoroquinolones are strongly linked to CDI, particularly with the emergence of hypervirulent strains 1, 2

Prolonged antibiotic therapy, defined as treatment courses greater than 10 days, significantly increases CDI risk 2
Concomitant proton pump inhibitor (PPI) use has been epidemiologically associated with increased CDI risk 3

Parenteral aminoglycosides are less frequently implicated in CDI 1, 4
Sulfonamides have a lower association with CDI development 1, 4
Macrolides are less commonly associated with CDI 2
Tetracyclines and tigecycline have a lower risk of CDI compared to high-risk antibiotics 1, 4

Discontinuing the inciting antibiotics is recommended when CDI is suspected or confirmed, if clinically possible 1, 4
Alternative antibiotic selection, choosing agents less frequently implicated with CDI, is recommended if continued antibiotic therapy is required for primary infection 1, 4
Discontinuing unnecessary PPIs in patients at risk for or with active CDI is recommended 3