Clostridium difficile guidance

Stop unnecessary antibiotics and/or proton pump inhibitors

Signs suggesting increased severity include:

  • Temperature greater than 38.5oC
  • WCC greater than 15
  • Rising creatinine
  • Signs/symptoms of severe colitis

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 1st episode and patient is well consider

If fewer than 4 loose stools in 24 hours, no abdominal pain and afebrile:

Metronidazole
  • Oral 400mg every 8 hours for 14 days
  • Ensure adequate hydration. Review patient regularly and escalate to severe if not improving. If the patient still requires antibiotics for the site of infection then discuss with microbiologist
For first relapse and recurrent or severe C. difficile disease

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:

Vancomycin
  • Oral 125mg every 6 hours for 14 days
  • Ensure Community Pharmacist is contacted to have stock available
  • If the patient still requires antibiotics for the site of infection then discuss with microbiologist. Ensure adequate hydration
  • Consider admission

Admit if severe:Temperature greater than 38.50C; WCC greater than 15, rising creatinine or signs/symptoms of severe colitis

Recurrent disease

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

Oral vancomycin:

  • 125mg every 6 hours for 14 days
  • 125mg every twelve hours for one week
  • 125mg once daily for one week
  • 125mg every other day for one week
  • 125mg every three days for 2 weeks

In the event of a treatment failure, return to six hourly vancomycin and repeat.

Saccharomyces boulardii
  • Sachet 250mg

Notes

  1. Saccharomyces boulardii has been included for the treatment of recurrent/relapsing Clostridium difficile infection on the recommendation of a consultant medical microbiologist or consultant gastroenterologist only.
  2. For use within South Devon Healthcare NHS Foundation Trust

 

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