Table 3 Current antibiotic treatment recommendations for CDI [1, 5, 10, 12]
From: Treatment of Clostridium difficile infection in community teaching hospital: a retrospective study
| IDSA (2010) | ACG (2013) | ESCMID (2014) | WDMH (2017) | |
|---|---|---|---|---|
| Initial episode of CDI | ||||
| Mild/moderate | Metronidazole 500 mg po q8h × 10–14 days |
Metronidazole 500 mg po q8h × 10 days (If no improvement in 5–7 days, consider change to severe CDI treatment) | Metronidazole 500 mg po q8h × 10 days | Metronidazole 500 mg po q8h × 10–14 days (If no improvement in 5 days or clinical worsening, change to CDI severe treatment) |
| Severe | Vancomycin 125 mg po q6h × 10–14 days | Vancomycin 125 mg po q6h × 10 days | Vancomycin 125 mg po q6h × 10 days | Vancomycin 125 mg po q6h × 10–14 days (If no response or symptoms worsening, consult Internal Medicine) |
| Severe and complicated |
Vancomycin 500 mg po q6h and metronidazole 500 mg iv q8h and (If ileus present: add vancomycin 500 mg in 100 mL NS pr q6h) | Vancomycin 125 mg po q6h, 500 mg in 500 mL saline as enema pr q6h and metronidazole 500 mg iv q8h |
Vancomycin 125–500 mg po q6h and metronidazole 500 mg iv q8h (Consider vancomycin pr or immunoglobulin iv) | |
| 1st recurrent episode of CDI | Same treatment as initial episode of CDI | Repeat metronidazole or vancomycin pulse regimen | Vancomycin 125 mg po q6h × 10 days | Same treatment as initial episode of CDI |
| 2nd recurrent episode of CDI | Vancomycin in a tapered and/or | Fecal transplant combined with oral antibiotic | Vancomycin 125 mg po q6h × 10–14 days | |
| pulsed regimen | treatment |
(Consider consulting Internal Medicine and a vancomycin tapering regimen or pulsed regimen i.e. vancomycin 125 mg po qid × 7 days, then 125 mg po bid × 7 days, then 125 mg po daily × 7 days, then 125 mg po q2d × 7 days then 125 mg po q3d × 14 days then discontinue) | ||
| Pregnant or patients intolerant to metronidazole | No recommendations | Vancomycin 125 mg po q6h × 10 days | No recommendations | Same treatment as severe CDI |