Clostridium difficile Infection (CDI)

Duration

10 Days

Overview of treatment

Important: Therapy

First Line - all severities

Important: Therapy

Vancomycin 125mg orally every 6 hours

IV Vancomycin cannot be used for treatment of CDI, as it does not penetrate into the lumen of the bowel.

Notes:

If patient is unable to swallow tablets please see Health Protection Scotland CDI guidance HPS CDI guidance for alternatives to oral therapy.

 

Second Line

Important: Therapy

  • Vancomycin 500mg orally every 6 hours,  ADD Metronidazole 500mg IV every 8 hours if any severity markers 

OR

  • Fidaxomicin* 200mg orally every 12 hours  

*Fidaxomicin is a protected antimicrobial.

 

Notes:

IV Vancomycin cannot be used for treatment of CDI, as it does not penetrate into the lumen of the bowel.

Patients who fail to improve after 7 days oral vancomycin or continue to deteriorate should be discussed with an infection specialist.

Life-threatening CDI

Important: Therapy

Vancomycin 500mg orally every 6 hours 

AND

Metronidazole 500mg IV every 8 hours

Notes:

IV Vancomycin cannot be used for treatment of CDI, as it does not penetrate into the lumen of the bowel.

Life-threatening CDI = any of the below attributable to CDI

  • admission to ICU
  • new onset hypotension with or without need for vasopressors
  • ileus or significant abdominal distension
  • new or worsening confusion
  • WBC > 35x10^9/L or Lactate >2.2 mmol/L
  • evidence of end organ failure

Patients with suspected life-theratening CDI should be referred for senior surgical review as a matter of urgency.

Recurrence within 12 weeks of diagnosis

Important: Therapy

Fidaxomicin 200mg orally every 12 hours

Notes:

If initial treatment course incomplete, treat as 1st episode.

Recurrence after >12 weeks from diagnosis

Important: Therapy

Use first line treatment option.

Notes:

 

 

Second recurrence

Important: Therapy

Discuss with infection specialist and consider Faecal Microbiota Transplant (FMT)

Important: Notes

CDI is a significant complication of antibiotic therapy and may be life-threatening. Any patient diagnosed with CDI requires prompt assessment, severity scoring and treatment.

Local guidance on diagnosis and management of CDI, including a severity assessment sheet for use in hospital, is provided on the Infection Prevention and Control site.

If patient is unable to swallow tablets please see Health Protection Scotland CDI guidance HPS CDI guidance for alternatives to oral therapy.

Intra-venous vancomycin must not be used to treat CDI - it does not penetrate into the lumen of the bowel.