In a patient with Clostridium difficile infection, should the feeding formula be changed to elemental?

• A. Yes
• B. No
• C. Only if diarrhea persists
• D. Only if other indications

Answer: (B)

The main idea is that the form of enteral nutrition is driven by digestion/absorption tolerance, not by the infection itself. Elemental formulas are useful when there is proven malabsorption or severe intolerance to standard feeds, because they’re pre-digested and easier to absorb. However, they come with higher osmolality, higher cost, and don’t treat the infection or inherently improve outcomes in Clostridium difficile infection. If the patient can tolerate a standard polymeric formula, it is appropriate and often preferred, while ensuring adequate calories and protein. Switch to elemental feeding only if there are specific indications like malabsorption or intolerance to polymeric feeds (for example, significant diarrhea not attributable to infection/treatment, or documented pancreatic insufficiency). Therefore, changing to elemental solely because of CDI is not indicated.