C difficile Infection (Antibiotic Associated Colitis)

Micro-organism

C difficile

Mild / Non - Severe

Metronidazole PO for 10 days

or

Vancomycin PO for 10 days

Maintain accurate stool chart

Severe

Vancomycin PO for 10 days

Add IV metronidazole if ileus or hypotension

CONSIDER URGENT SURGICAL REVIEW

Maintain accurate stool chart

Consider systemic antibiotics (Vancomycin IV + gentamicin IV + metronidazole IV) if severe colonic inflammation in addition to above therapy

Notes

Observe bowel movements, symptoms, (WCC and hypotension) and fluid balance. If symptoms continue to worsen, refer to gastroenterology / surgery, and discuss with microbiology.

Ensure infection control measures are in place including stool chart - do no wait for confirmation of diagnosis

Send stool sample

Stop and (non-Clostridium difficile) antimicrobial treatment in patients with CDI if possible

Stop any antimotility agents, laxatives and gastric acid suppressants if possible

Rehydrate patient

Assess symptoms and severity of disease on a daily basis