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Escalation of immunosuppression medications should be avoided in the setting of untreated CDI. (Conditional recommendation, low-quality evidence). Management of concomitant immunosuppression in such patients is challenging, including when to treat a patient for CDI when they present with what appears to be an exacerbation of IBD. The decision to wait for a positive test to prove CDI or institute empirical therapy should be guided by severity of presentation.
For mild-to-moderate cases, it is appropriate to treat for an IBD flare alone if there are no specific additional risk factors for C.