Management of CDAD Flashcards
What antibiotics are most likely to cause CDAD?
- Clindamycin
- 3rd and 4th generation cephalosporins
- Fluoroquinolones
What precautions should be taken to prevent transmission of CDAD?
- Isolate patients with CDI in a private room w dedicated toilet to decrease transmission to other patients
- don PPE, wash hands w soap and water
- use sporicidal agents for cleaning
- minimize the frequency and duration of high risk antibiotic therapy and the number of antibiotic agents prescribed to reduce CDI risk
What are the criteria to decide if a CDAD episode is severe or non-severe?
Non-severe CDAD should not fulfil either of these criteria:
- WBC ≥15 x 109/L OR
- SCr ≥ 133 μmol/L
What are the first line treatment options for non-severe CDAD?
- PO Fidaxomicin 200mg BD
- PO Vancomycin 125mg 4 times a day
Both for 10 days - can extend to 14 days max if symptoms not completely resolved
What is the alternative treatment for non-severe CDAD?
PO Metronidazole 400mg TDS x 10/7
What are the treatment options for severe CDAD?
- PO Fidaxomicin 200mg BD
- PO Vancomycin 125mg 4 times a day
Both for 10 days - can extend to 14 days max if symptoms not completely resolved
What symptoms signal fulminant CDAD?
Hypotension OR ileus OR megacolon
What are the treatment options for fulminant CDAD?
IV Metronidazole 500mg Q8H
+ PO Vancomycin 500mg 4 times a day
+ PR Vancomycin 500mg 4 times a day
Both for 10 days - can extend to 14 days max if symptoms not completely resolved
What treatment can be given for the first recurrence of CDAD that was previously treated with metronidazole?
PO Vancomycin 125mg 4 times a day x 10 days
What treatment can be given for the first recurrence of CDAD that was previously treated with vancomycin or fidaxomicin?
- PO Fidaxomicin 200mg BD x 10 days
- PO Fidaxomicin 200mg BD x 5 days, then every other day for 5 days
- PO Vancomycin tapered (125mg 4 times a day x 10-14 days, then 125mg BD x 7 days, then 125mg OD x 7 days, then 125mg every 2-3 days x 2-8 weeks
