Diarrhoea - antibiotic associated (C-Difficile)

Question 1

What are the 4C’s?

Answer 1

Four broad-spectrum antibiotics that have a risk increased risk of C.difficile occurring in people and also antibiotics that should be avoided to preserve them from resistance.

co-amoxiclav, cephalosporins, fluoroquinolones and clindamycin.

Question 2

How should it be managed before antibiotic treatment?

Answer 2

Stop the causative antibiotic
Manage fluid loss and symptoms
Avoid antimotility drugs like loperamide
Review PPI use

Question 3

What antibiotics are used to treat it?

Answer 3

First-line for a first episode vancomycin 125mg orally four times a day for 10 days

Second-line for first episode fidaxomicin 200mg orally twice a day for 10 days