Treatment of life-threatening infection

Antimicrobial prescribing: NHS Lothian
NHS Lothian

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

  • admission to ICU for CDI
  • hypotension with or without required use of vasopressors
  • ileus or significant abdominal distension
  • mental status change
  • WBC ≥35 cells x 109 /L or <2 cells x 109 /L
  • serum lactate >2.2 mmol/l
  • end organ failure (mechanical ventilation, renal failure)

Surgical review MUST be obtained

Antimicrobial Recommendation

Vancomycin 500 mg every 6 hours orally (if oral route not available give via alternative enteral route)

PLUS

Metronidazole 500mg every 8 hours IV

Duration = 10 days

If the patient has a critical illness attributed to CDI infection specialists may consider IVIG. Guidance for use in critical care is available here.