Management of Suspected Clostridium Difficile Infection (CDI)

Antimicrobial prescribing: NHS Borders
NHS Borders

Duration

10 days

Clostridium difficile Infection (CDI)-first episode– Mild, moderate or severe infection

Therapy

Vancomycin Oral 125mg 6 hourly

Notes:

Clostridium difficile Infection (CDI)-first episode– of mild, moderate or severe infection where patients fail to improve after 7 days or worsen with oral vancomycin

Therapy

Discuss with Infection Specialist. Treatment will depend on severity and clinical setting.

Fidaxomicin Oral 200mg 12 hourly

 

Or

 

Vancomycin oral 500mg 6 hourly

+/- Metronidazole IV 500mg 8 hourly

(IV metronidazole can be reviewed and discontinued if patient improving)

Notes:

Clostridium difficile Infection (CDI)-life threatening infection

Therapy

Seek urgent specialist advice, including surgical review

Life threatening CDI is when a patient has any of the following attributable to CDI:

Admission to ICU, hypotension with or without need for vasporessors, ileus or significant abdominal distension, mental status changes, WBC ≥35 x 109 or <2 X 109/L, serum lactate greater than 2.2 mmol/L or end organ failure (mechanical ventilation, renal failure).

 

Specialists may offer:

Vancomycin Oral 500mg 6 hourly

+/- metronidazole IV 500mg 8 hourly

(IV metronidazole can be reviewed and discontinued if patient responds well)

Notes:

Notes

  • If second or subsequent episode, or patients who fail to improve, discuss with Infection Specialist
  • Review and document severity of disease daily

  • - evidence of severe colitis in CT scan or X-ray

    - Temperature >38.5 °C

    - suspicion or/confirmed pseudomembranous colitis, toxic megacolon or ileus

    - acute rising serum Creatinine .1.5 x baseline

    - WBC>15 x 109/L

 

  • Advise on

         - drinking enough fluids to avoid dehydration

         - preventing the spread of infection

         - seeking medical help if symptoms worsen rapidly or significantly at any time