Clostridium Difficile Treatment

Question 1

What is the criteria for diagnosing C.difficile?

Answer 1

Diarrhoea and one of the following:

• +ve C.difficle test
• if pending results, need clinical suspicion of CDI

Question 2

What do you do in both types of CDI?

Answer 2

• Continue non-difficile ABX to allow normal intestinal flora to be re-established
• Isolate patient
• Daily assessment

Question 3

When should diarrhoea resolve in CDI?

Answer 3

within 1-2 weeks

Question 4

How do you treat non-severe CDI and what parameters are in this type?

Answer 4

• WCC < 15
• No rising creatinine
• No colitis

ORAL METRONIDAZOLE 400MG TDS for 10-14 days

Question 5

What do you do if symptoms don’t improve in non-severe CDI?

Answer 5

• After 7 days or symptoms of severe CDI

- Oral vancomycin 125mg QDS 10-14 days

Question 6

What should not be prescribed in acute CDI?

Answer 6

Antimotility agents e.g. Loperamide

Question 7

How do you treat severe CDI and what parameters are in this type?

Answer 7

• WCC > 15
• Acute rising creatinine
• Colitis

ORAL VANCOMYCIN 125MG QDS for 10-14 days

Question 8

What do you do if symptoms don’t improve in severe CDI?

Answer 8

• After 7 days
• Surgery/GI/microbiology/ infectious diseases consultation
• Consider intracolonic vancomycin
• Vancomycin 500mg WDS
• Consider IV immunoglobulin 400mg/kg 1 dose

Question 9

How do you treat recurrent Clostridium difficile infection?

Answer 9

• Within 30 days and +ve C.difficile test
• Discontinue non-difficile ABX. Review all drugs with GI side effects
• Isolate patient
• Oral fidaxomicin 200mg BD 10-14 days

Question 10

If multiple recurrences (especially if evidence of wasting, malnutrition), what do you do?

Answer 10

1. Review all drug therapy
2. Consider supervised trial of antimotility agents alone
3. Fidaxomicin 200mg BD 10-14 days if not used yet
4. Vancomycin pulse therapy 4-6 weeks
5. IV immunoglobin
6. Donor stool transplant –> faecal microbiota transplantation via colonoscopy