Clostridioides difficile (Clostridium difficile)
Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
Warning
- Consider a non-infectious cause for the patient’s symptoms e.g. laxatives.
- Establish if the patient has diarrhoea (≥3 loose stools [Bristol stool chart 5 – 7] in the last 24h or if ≥3 loose stools is normal for the patient, are the number of loose stools more than baseline?
- Asymptomatic patients and/or those with an alternative non-infectious cause of their loose stools do not routinely need empirical treatment or laboratory testing.
- If Clostridioides difficile infection (CDI) clinically suspected, send stool sample.
- Stop any (non-Clostridioides difficile) antimicrobial treatment in patients with CDI if possible.
- Review any concurrent gastric acid suppressant therapy and reduce or stop if appropriate.
- Review and stop any anti-motility agents to reduce the risk of toxic megacolon development.
- Stop any laxatives for duration of symptoms (remember laxatives may be an alternative cause of the loose stools).
- Stop any medicines that can be a risk if dehydrated (diuretics, ACE inhibitors, ARBs, NSAIDs, metformin, SLGT2 inhibitors) ie Sick Day Rules.
- Assess and document symptoms and severity of disease taking into account individual risk factors for patient.
- Do not routinely treat patients with an equivocal C. difficile result.
- For patients with a positive C. difficile toxin result, a clinical assessment is required to assess whether the patient meets the CDI case definition. Refer to algorithm on Grampian Guidance (intranet only).
- Submitting stool samples as a test of cure is not advised as patients may remain C. difficile toxin positive despite clinical improvement.
- For treatment advice in children contact Medical Microbiology.
Drug details
First Episode – first line option for Adults
Oral Vancomycin
125mg four times daily
10 days
If there is a delay in obtaining a supply of oral vancomycin then metronidazole can be prescribed initially to prevent a delay in starting treatment. Metronidazole should be substituted with oral vancomycin as soon as availability is resolved to complete a total of 10 days treatment.
First Episode – second line option
Discuss with infection specialist
Second Episode
Discuss with infection specialist