Clostridioides Difficile
NICE (published July 2021)
HPS (published September 2017)
SAPG Advice statement (published February 2022)
SAPG Guidance on Antimicrobial Management of CDI in Children(published July 2022)
Drug details
First episode (non-life threatening)
Vancomycin (ORAL ONLY) 125mg four times daily
10 days
Review at 7 days for effectiveness
If vancomycin unavailable for 24 hours and ONLY if agreed with Microbiology
Metronidazole (oral) 400mg three times a day
Until vancomycin available
Complete 10 days of treatment in total
Life-threatening infection – seek specialist advice
Vancomycin 500mg (oral or enteral) four times a day
PLUS
Metronidazole (intravenous) 500mg three times a day
10 days
First recurrent episode, on advice from microbiology
Fidaxomicin 200mg twice daily
OR
Pulsed/tapered vancomycin
Week |
Dose |
Frequency |
1 |
125mg |
4 times a day |
2 |
125mg |
3 times a day |
3 |
125mg |
Twice a day |
4 |
125mg |
Once a day |
5 |
125mg |
Every second day |
6 |
125mg |
Every 3 days |
Total quantity to supply: 80 doses |
10 days
6 weeks
Second and subsequent recurrence of infection
Contact Infection Prevention and Control Team or Consultant Microbiologist.
Severity Assessment
Mild to moderate CDI
Severe CDI is associated with at least one of the following
Life-threatening CDI
Includes hypotension, ileus or significant abdominal distension, mental status changes, WCC > 35 or <2 x 109L, serum lactate > 2.2mmol/l or end organ failure.
Taken from box 5, page 24 of Scottish Health Protection Network Guidance on Prevention and Control of Clostridioides difficile Infection (CDI) in Health and Social Care Settings in Scotland
Antibiotic Treatment
Discuss each case with Microbiology to agree optimal treatment, including availability of vancomycin and fidaxomicin.