Clostridium difficile Infection

Antimicrobial prescribing: NHS Fife
NHS Fife

Clinical features

Criteria for severe infection (any one from the following)

  • In  ITU for CDI or complications        
  • Suspected /confirmed ileus, toxic megacolon, pseudomembranous colitis
  • Temp >38.5oC
  • White cell count >15                      
  • Acutely rising serum creatinine, or creatinine >1.5 times baseline
  • Colonic dilatation >6cm 
  • Immunocompromised

Investigations

Stool (culture and C difficile toxin)

Test of clearance is not indicated for C. difficile positive patients. stool sample should not be sent within 28 days of a positive result and will not be tested.

Infection Control

Isolation with contact precautions

Treatment

  • Rehydrate
  • Assess daily
  • Complete the medical management form (available via Infection Control homepage)
  • Stop other antimicrobials if possible
  • Stop PPI if possible
  • Stop antimotility agents and laxatives
  • Consider surgical review in severe disease
  • Discuss all recurrences with Microbiology - Fidaxomicin (protected antibiotic) may be indicated instead of regimens given below

Non-severe, 1st episode

METRONIDAZOLE PO 400mg 8 hourly

If not better after 5 days, change to VANCOMYCIN PO as below

Severe, 1st episode

VANCOMYCIN PO 125mg 6 hourly

 If PO route not available

METRONIDAZOLE IV 500mg 8 hourly

Duration:  10 days