Table 2.
Recommendations for the treatment of Clostridium difficile infection†.
| Clinical situation | Description | Recommended treatments |
|---|---|---|
| All | Stop inciting antibiotics whenever possible | |
| Initial episode: nonsevere | >3 unformed or watery stools per day and a stool test result positive for toxigenic C. difficile or its toxins, or pseudomembranous colitis on colonoscopic or histopathologic examination | Metronidazole, 500 mg by mouth three-times a day for 10–14 days |
| Initial episode: severe | Leukocytosis with white blood cell count >15,000 cell/ml and a serum creatinine >1.5-times the premorbid level |
Vancomcyin 125 mg by mouth four-times a day for 10–14 days‡ |
| Initial episode: severe and complicated | Hemodynamic instability, ileus or toxic megacolon§ Fever (>38.5°C), rigors, peritonitis, band neutropihils >20% of leukocytes; elevated serum lactate, pseudomembranous colitis, colonic wall thickening, pericolonic fat stranding, ascitics without another cause¶ |
Vancomycin 500 mg four-times a day by mouth or through nasogastric tube; metronidazole 500 mg intravenously If complete ileus, consider adding rectal installation of vancomycin Surgical consultation |
| Indications for colectomy | Colonic perforation Failure to respond to antibiotic treatment with a deteriorating clinical status, including toxic megacolon or severe ileus |
|
| Recurrent disease: first episode | Same as for initial episode | |
| Recurrent disease: subsequent episodes | Vancomycin taper or pulse therapy# |
Based on both the Society for Healthcare Epidemiology of America/Infectious Disease Society of America and European Society of Clinical Microbiology and Infectious Disease treatment guidelines.
Where available, teicoplanin 100 mg by mouth twice a day may replace oral vancomycin.
Per the Society for Healthcare Epidemiology of America/Infectious Disease Society of America Guidelines.
Per the European Society of Clinical Microbiology and Infectious Disease Guidelines.
Vancomycin 125 mg by mouth four-times a day for 10–14 days followed by vancomycin 125 mg by mouth twice a day for 1 week, 125 mg by mouth once daily for 1 week and then 125 mg by mouth every 2–3 days for 2–8 weeks.