Treatment of first episode of CDI

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Review severity markers (see Severity of Infection)

Vancomycin 125 mg every 6 hours orally

Duration = 10 days

If oral route not available give via alternative enteral route.

Review and document severity of disease daily.

Diarrhoea can take one to two weeks to resolve and it is not usually possible to determine whether antibiotic treatment is ineffective until day 7.

For patients who fail to improve after 7 days or worsen with oral vancomycin discuss with infection specialist and review options for treatment failure below.

Treatment failure

For patients who fail to improve after 7 days or worsen with oral vancomycin discuss with an infection specialist (see How to get advice). Treatment will be dependent on clinical setting/severity of disease. 

Antimicrobial recommendations:

Fidaxomicin 200mg every 12 hours orally

Duration = 10 days

OR

Vancomycin 500 mg every 6 hours orally

Duration = 10 days

PLUS

Metronidazole 500mg every 8 hours IV until improving or until 10 days has been completed