Clostridioide Difficile Infection

Question 1

What are the antibiotics that can cause C.diff

Answer 1

Broad spectrum antibiotics:

Clindamycin, 3rd/4th Gen Cephalosporins, FQ

Question 2

What are the antibiotics protective against C.Diff

Answer 2

Doxycycline, Tigecycline

Question 2

Apart from ASP, what can be done to reduce the risk of C.diff

Answer 2

Isolation (with dedicated toilet), Hand hygiene, environmental cleaning

Discontinue unnecessary PPI
Potential use of probiotics

Question 3

Who should be tested for C.Diff

Answer 3

Patients with symptomatic diarrhoea (>= 3 unformed stools per day) & the patient must not have laxatives over the past 48hrs

Question 4

Who should not be tested for C.Diff

Answer 4

1. Asymptomatic patients
2. Patients who did the test over the past 7 days
3. Repeat care to document cure (majority of those who improve will still show positive test)

Question 5

What is the WBC and SCr that points to severe C.Diff

Answer 5

WBC ≥15 x 10^9 /L OR Scr≥133µmol/L (1.5 mg/dL)

Question 6

What is consider fulminant C.Diff

Answer 6

Hypotension OR ileus (intolerance of oral intake) OR Megacolon

Question 7

What are the drugs to treat non-severe C.Diff (initial)? (Drug, Dose, Frequency)

Answer 7

First Line
POFidaxomicin 200mg BD
OR
POVancomycin 125mg QDS

Alternative
POMetronidazole 400mg TDS (Only used when patient is stable and minimal comorb)

Question 8

What is the treatment duration for C.Diff

Answer 8

10 days (May extend to 14 days if sx are not completely resolved)

Question 9

What are the drugs to treat severe C.Diff (initial)? (Drug, Dose, Frequency)

Answer 9

POFidaxomicin 200mg BD
OR
POVancomycin 125mg QDS

Question 10

What are the drugs to treat fulminant C.Diff (initial)? (Drug, Dose, Frequency)

Answer 10

IVMetronidazole 500mg Q8H + POVancomycin 500mg QDS

± PRVancomycin 500mg QDS