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- IDSA/SHEA recently released a guideline update for the management of Clostridium difficle infections
- Discontinue inciting antibiotic therapy as soon as possible
- Metronidazole is no longer considered first line therapy for C. difficle infection
- Treatment course for 10 days unless initial fulminant or recurrence requiring vancomycin taper
- Remember: Vancomycin IV does not cross into the GI tract and cannot be used to treat C. difficile
| Clinical Definition | Treatment | |
| Initial episode, non-severe | WBC ≤ 15,000 AND SCr <1.5 |
If above agents unavailable, metronidazole PO 500mg 3x daily
|
| Initial episode, severe | WBC ≥ 15,000 OR SCr >1.5 |
|
| Initial episode, fulminant | Hypotension, shock, ileus, megacolon |
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| First Recurrence |
|
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References
McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical Infectious Diseases. 2018;66(7):e1-e48.
PMID: 29562266