Description: C diff diarrhea Epic smart phrase, including basic 2010 IDSA guideline recommendations on treatment with flagyl and vancomycin.
Diagnosis of C difficile diarrhea:
- 3 or more unformed stools in 24 or fewer consecutive hours
- Positive test C. difficile and its toxins (conducted on unformed, diarrheal stool sample – only exception is suspected ileus).
- Stop inciting antimicrobial therapy (all agents in the same class) ***.
- Avoid probiotic (lack of clinical data and the potential risk of blood stream infection) and antiperistaltic agents (might interfere with symptoms of infection; might increase the risk of toxic megacolon).
- @BRIEFLAB(WBC)@ ***> or <*** 15
- @BRIEFLAB(creat)@ ***> or <*** 1.5xbaseline Cr of ***
- Treat with:
- If first episode, WBC<15 and Cr<1.5x baseline (mild-moderate disease) then Metronidazole 500 mg PO TID 10-14 days
- If first episode, WBC>15 or Cr>1.5x baseline (sever disease) then vancomycin 125mg QID PO 10-14 days
- If first episode with hypotension, shock, ileus or megacolon then vancomycin 500mg QID PO/NGT plus metronidazole 500 mg IV Q8h. Consider vancomycin per rectum with ileus or ostomy.
- First recurrence, treat same as first episode
- Second recurrence, use vancomycin PO in a tapered or pulsed regimen
1. Cohen SH et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010; 31(5):000-000.
2. Gerding, DN et al. Treatment of Clostridium difficile Infection. Clin Infect Dis 2008; 46:S-32-42.