Clostridioides Difficile Infection (CDI)

Micro-organism

Clostridioides difficile

Duration

10 Days

Notes
  • If CDI suspected, start treatment and ensure infection control measures are in place – do not wait for confirmation of diagnosis
  • Send stool sample
  • Stop any (non- Clostridioides difficile) antimicrobial treatment in patients with CDI if possible.
  • Review any concurrent gastric acid suppressant therapy and reduce or stop if appropriate.
  • Review and stop any anti-motility agents to reduce the risk of toxic megacolon development.
  • Stop any laxatives for duration of symptoms.
  • Rehydrate patient.
  • Assess symptoms and severity of disease taking into account individual risk factors for patient:

 

Severity Markers

  • Temperature >38.5°C
  • Consider severe co-morbidities/immunodeficiency
  • Suspicion of pseudomembranous colitis, toxic megacolon, ileus
  • Evidence of severe colitis on CT scan/ x-ray
  • White blood cell count >15 x 109cells/L
  • Acute rising creatinine >1.5 x baseline

 

NB: Alcohol gel does not kill C difficile spores – follow hand-washing guidance.

 

For further information refer to local protocol and Health Protection Network Scottish Guidance (September 2017).

 

Seek specialist advice if appropriate.

First Episode: Non severe (no severity markers)

Metronidazole oral 400mg three times daily

If condition does not improve after 5 days, switch to oral vancomycin.

 

Assess patient daily. Observe bowel movement, symptoms (WBC and hypotension) and fluid balance. If symptoms continue to worsen, refer to surgery, gastroenterology and microbiology.

*If patient is pregnant/breastfeeding, vancomycin should be used 1st line.

First Episode: Severe (1 or more severity markers or no improvement after 5 days of metronidazole)

Vancomycin oral 125mg 6 hourly

Consider adding Metronidazole IV 500mg 8 hourly (if ileus or hypotension)

Assess patient daily. Observe bowel movement, symptoms (WBC and hypotension) and fluid balance. If symptoms continue to worsen, refer to surgery, gastroenterology and microbiology.

*If patient is pregnant/breastfeeding, vancomycin should be used 1st line.

Second Episode or Subsequent Recurrence

Discuss treatment options with Medical Microbiologist or Infection Specialist.