Skip to main content
. 2017 Jul 21;23(27):4986–5003. doi: 10.3748/wjg.v23.i27.4986

Table 4.

Treatment of clostridium difficile infection in inflammatory bowel disease[3,4]

Severity Criteria Treatment Comments
First episode
Stop all non-CDI related antibiotic therapy if possible
Mild to moderate disease Diarrhea and symptoms not meeting criteria for severe disease Metronidazole 500 mg by mouth 3 times per day for 10 d to 14 d In hospitalized patients with UC and nonsevere CDI, treatment with a vancomycin-containing regimen vs metronidazole alone resulted in fewer readmissions and shorter LOS[70]
or
Vancomycin 125 mg by mouth 4 times per day for 10 to 14 d
Severe disease Serum albumin < 3 g/dL AND one of the following: Vancomycin 125 mg by mouth 4 times per day for 10 to 14 d
WBC ≥ 15000 cells/mm3
Abdominal tenderness
Creatinine ≥ 133 μmol/L
Severe, complicated disease Admission to intensive care unit Vancomycin 500 mg by mouth or nasogastric tube 4 times per day Consider early surgical consultation
Hypotension ± vasopressor requirement and
Fever ≥ 38.5 °C Metronidazole 500 mg IV every 8 h
Ileus and, if ileus,
Mental status changes Vancomycin 500 mg in 500 mL saline as enema 4 times per day
WBC ≥ 35000 cells/mm3 or ≤ 2000 cells/mm3
Serum lactate ≥ 2.2 mmol/L
End organ failure
Recurrent CDI
First recurrence Metronidazole 500 mg by mouth 3 times per day for 10 to 14 d
or
Vancomycin 125 mg by mouth 4 times per day for 10 to 14 d
or
Fidaxomicin 200 mg by mouth 2 times per day for 10 d
Second recurrence -Tapered and pulsed vancomycin
or
Fidaxomicin 200 mg by mouth 2 times per day for 10 d
Subsequent recurrence -Fecal microbiota transplant

LOS: Length of stay; CDI: Clostridium difficile infection; UC: Ulcerative colitis.