Clostridium difficile Infection (CDI)
Duration
10 Days
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.
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.
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.
Important: Therapy
Fidaxomicin 200mg orally every 12 hours
Notes:
If initial treatment course incomplete, treat as 1st episode.
Important: Therapy
Use first line treatment option.
Notes:
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.