Treating Helicobacter pylori and Recurrent Clostridioides difficile Coinfection: A Delicate Balance in Management and a Need for Guidelines

Abstract

Treating Helicobacter pylori and Clostridioides difficile coinfection presents a challenging clinical dilemma. Treating H. pylori may increase the risk of C. difficile, and antibiotics generally have been shown to increase the risk of C. difficile infection/recurrence. While it may be reasonable to delay H. pylori treatment, this is especially challenging when there is an acute indication to treat H. pylori such as peptic ulceration or bleeding. There are no guidelines on the management of H. pylori and C. difficile coinfection. We report a patient who had H. pylori and recurrent C. difficile coinfection and suggest a management algorithm based on literature review and our institutional experience. Our patient received quadruple therapy for H. pylori along with vancomycin prophylaxis, taper, and a dose of bezlotoxumab and experienced good outcomes with resolution of his gastrointestinal bleeding and diarrhea.

Keywords: Clostridioides difficile; Helicobacter pylori; coinfection; outcomes.

Figure 1.

Endoscopic image of a giant at least 2 cm punched-out ulcer at the junction of the first and second portions of the duodenum.

Figure 2.

Suggested algorithm for treating Clostridioides difficile and Helicobacter pylori coinfection based on disease and patient-specific characteristics, literature review, and our institution experience.