C Diff Infection Flashcards
C Diff Infection (CDI) Signs and Symptoms
At least 3 unformed stools in 24 hours AND stool (+) for C diff toxins OR
Colonoscopic/histopathologic demonstrating pseudomembranous colitis
Non-Severe CDI
WBC < 15k cells/mL
SCr < 1.5 mg/dL
No hypotension, shock, or toxic megacolon
Severe CDI
WBC > 15k cells/mL
SCr > 1.5 mg/dL
No hypotension, shock, or toxic megacolon
Fulminant CDI
WBC > 15k cells/mL
SCr > 1.5 mg/dL
Presence of hypotension, shock, or toxic megacolon
General CDI Treatment Principles
Do NOT treat asymptomatic disease
Discontinue offending antibiotic if possible
Avoid antiperistaltic agents, such as loperamide
Supportive care - hydration and electrolyte replacement
Surgical intervention - only for fulminant CDI not responding to first-line agents
Antibiotics do NOT kill spores
Treatment of Initial CDI Episode (non-fulminant)
Preferred: Fidaxomicin 200 mg PO BID x 10 days
Alternative: Vancomycin 125 mg PO QID x 10 days
Alternative for Non-Severe CDI: Metronidazole 500 mg PO TID x 10 days
Treatment of Initial CDI Episode (Fulminant)
Vancomycin 500 mg PO/NG QID
If ileus, consider administering vanco rectally
If ileus, add Metronidazole 500 mg IV q8h to vanco
Treatment First CDI Recurrence
Preferred: Fidaxomicin 200 mg PO BID x 10 days OR 200 mg PO BID x 5 days, followed by once every other day x 20 days
Alternative: Vancomycin 125 mg PO QID x 10 days
Alternative: Vancomycin PO tapered/pulsed regimen
Adjunct: Bezlotuximab 10 mg/kg IV x 1 dose
Treatment of Recurrent CDI (at least 2 recurrences)
Fidaxomicin 200 mg PO BID x 10 days OR 200 mg PO BID x 5 days, followed by once every other day x 20 days OR
Vancomycin 125 mg PO QID x 10 days, followed by Rifampin 400 mg TID x 20 days OR
Vancomycin PO tapered/pulsed regimen OR
Fecal transplant
Adjunct: Bezlotuximab 10 mg/kg IV x 1 dose
Bezlotoximab
NOT an antibiotics and must be used in conjunction with vanco PO or fidaxomicin
Binds to C. diff toxin B and neutralizes its effects
