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Stop unnecessary antibiotics and/or proton pump inhibitors
Signs suggesting increased severity include:
Patients with severe infection should be admitted
All stool samples sent in to microbiology from patients over 65 or with a history of antibiotic use on their clinical details or if requested will be tested provided the patient has diarrhoea (Bristol Stool Chart 5-7) that is not clearly attributable to an underlying condition (e.g. inflammatory colitis, overflow) or therapy (e.g. laxatives, enteral feeding).
If fewer than 4 loose stools in 24 hours, no abdominal pain and afebrile:
If patient appears unwell and has any number of loose stools in 24 hours or the patient has had previous Clostridium difficile disease within the last 6 months:
Admit if severe:Temperature greater than 38.50C; WCC greater than 15, rising creatinine or signs/symptoms of severe colitis
Recurrent disease will be experienced by up to one third of patients. A tapering course of vancomycin may prevent relapse: 125mg every 6 hours for 14 days
In the event of a treatment failure, return to six hourly vancomycin and repeat.