C diff Tayside Guidelines

Question 1

What are the risk factors for c diff infection?

Answer 1

History of recent (<3m) or current antibiotic use
Prolonged recent hospital stay
Use of PPI/H2 antagonists
Increasing age especially > 65y
Surgical procedure (in particular bowel procedures)
Immunosuppression

Question 2

When is c diff infection classed as severe?

Answer 2

One or more of:
Temperature > 38.5°C
Ileus, colonic dilatation >6cm on AXR/CT, toxic
megacolon and/or pseudomembranous colitis
WBC >15 cells x 10*9L
Acute rising serum creatinine >1.5 x baseline
Has persisting CDI where the patient has remained symptomatic and toxin positive despite 2 courses of appropriate therapy

Question 3

1st line management of c.diff infection

Answer 3

Oral or NG vancomycin for 10 days
(new guidance doesn’t include metronidazole)

Question 4

2nd line management of c diff infection

Answer 4

Discuss with ID
Oral fidoxamicin 10 days
OR
Higher dose oral vancomycin and IV metronidazole

Question 5

When is c diff considered recurrent?

Answer 5

When recurs within 12 weeks of first test

Question 6

Management of first recurrence of c diff?

Answer 6

Contact ID
Oral fidaxomicin

Question 7

Management of second recurrence of c diff?

Answer 7

Consider faecal transplant
If not possible vancomycin tapering regime