Clostridium difficile Infection Initial Episode
Mild or Moderate Leukocytosis < 15,000 and creatinine < 1.5X pre-morbid level A-I metronidazole PO 500 mg tid for 10-14 days Severe
Leukocytosis ≥ 15,000 or creatinine ≥ 1.5X pre-morbid level
B-I vancomycin PO 125 mg qid for 10-14 days 1st Reccurrence If complete ileus: A-II Same as for initial episode 2nd Reccurrence B-III vancomycin, tapered/pulsed
Drugs for Oral Therapy Agent
metronidazole
250 mg 500 mg
vancomycin
125 mg & 250 mg capsules Alternative: 500 mg/100 mL; 1 g/200 mL liquid
Clinical Definition
Initial episode, mild or moderate
Initial episode, severe
Initial episode, complicated
First recurrence Second recurrence
Supportive Clinical Data
Leukocytosis < 15,000 and creatinine < 1.5X pre-morbid level
Leukocytosis ≥ 15,000 or creatinine ≥ 1.5X pre-morbid level
Hypotension or shock, ileus, megacolon
consider adding rectal instillation of vancomycin
Complicated
Hypotension or shock, ileus, megacolon
C-III vancomycin
500 qid PO or via NG tube plus metronidazole IV 500 mg q8h
How Supplied
Side Effects
Common: nausea, headache, anorexia, vomiting, diarrhea, epigastric distress, abdominal cramping, constipation Serious: convulsive seizures, peripheral neuropathy
Extremely rare with oral use Recommendations for the Treatment of Clostridium difficile Infection
Recommended Treatment
metronidazole 500 mg PO tid for 10-14 days
vancomyin 125 mg PO qid for 10-14 days
vancomyin 500 mg qid PO or via NG tube, plus IV metronidazole 500 mg q8h If complete ileus: consider adding rectal instillation of vancomycin
Same as for initial episode vancomycin, tapered/pulsed
3
