Clostridioides difficile Infection (CDI)
***CPRS Order menus available for ambulatory care, inpatient, ED, and CLC***
Clinical Definition | Supportive Clinical Data |
Asymptomatic colonization | Positive C. difficile PCR (only) WITHOUT diarrhea, ileus, or colitis |
Active infection |
Diarrhea ( > 3 unformed stools / 24 hours) AND either - Positive C. difficile PCR AND positive toxin A/B OR - Presence of pseudomembranous colitis on colonoscopic or histopathologic exam |
Recurrent infection | Active infection that occurs within 8 weeks after completing treatment of prior CDI episode |
Fulminant | Active infection PLUS hypotension, shock, ileus, megacolon, or perforation |
C. difficile Treatment Regimens
Initial episode |
Vancomycin 125 mg PO q6h for 10 days OR Fidaxomicin 200 mg PO q12h for 10 days for patients at increased risk of CDI recurrence (at least 1):
|
1st Recurrence | Fidaxomicin 200 mg PO q12h for 10 days |
≥ 2nd Recurrence |
Vancomycin oral solution in a tapered regimen:
PLUS ID or GI consult for fecal microbiota transplant (FMT) evaluation (i.e., VOWST) |
Fulminant |
Vancomycin 500mg PO q6h
|
C. difficile Prophylaxis Agents
Vancomycin 125 mg PO q12h |
Must meet ALL of the following criteria:
Initiate as soon as possible and continue until antibiotics not directed against CDI are discontinued |
VOWST™ (FMT)
ID or GI section approval is required
Place pharmacy non-formulary drug consult (PADR) |
Must meet ALL of the following criteria:
Patients are ineligible if ONE of the following criteria are met:
Pretreatment:
Treatment:
|
Clinical Pearls
- If an inciting antimicrobial is suspected discontinue the agent as soon as possible.
- The use of antimotility agents (loperamide, etc.) should be avoided.
- If severe or fulminant disease is suspected, initiate empiric treatment while awaiting assay results. If the assay is negative, use clinical judgment when deciding if therapy should be discontinued.
- Use caution with high dose oral/rectal vancomycin (500mg Q6H) in patients with renal insufficiency, as significant absorption can occur in the setting of colitis and systemic accumulation could lead to ototoxicity, nephrotoxicity, or other adverse effects.
- Always wash hands with soap and water after examining a patient with suspected/confirmed C. difficile, as alcohol-based sanitizers do NOT kill spores.
- Fidaxomicin and vancomycin PO are ONLY orderable through the CDI order menus (inpatient, CLC, ED, and ambulatory care)