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C.diff (Nonpharmacologic (Soap + water >> alcohol, Fluid &…
C.diff
Nonpharmacologic
Soap + water >> alcohol
Fluid & electrolyte replacement
Discontinue antibiotic therapy
Contact precautions
FMT for severe/recurrent
Pharmacologic
Non-severe
WBC <15, SCr <1.5
Vanc 125mg PO QID x 10d (standard)
Fidaxomicin 200mg PO BID x10d (standard)
Metronidazole 500mg PO q8h x10d
Severe
WBC >15, SCr >1.5
Vanc standard
Fidaxomicin standard
Fulminant
Hypotension or shock; ileus or megacolon
Metronidazole 500mg IV q8h PLUS vanc 500mg PO or NG (rectal if ileus) QID
Recurrence
25-35%
First recurrence
If started on metronidazole
Vanc standard or vanc tapered/pulsed
If started on vanc
Fidaxomicin standard
Second or subsequent recurrence
Vanc stand or vanc tapered/pulsed
FMT
Alternates
bezlotuxumab
Neutralizes toxin B
adjunctive therapy
IVIG
tigecycline
Counseling
Metronidazole
Metallic taste
Avoid alcohol
irreversible neurotoxicity
Vanc
GI upset
N/V
Abdominal pain
Finish entire course
Etiology
Risk factors
Antibiotic use
Advanced age
Chemo, immunocompromised
PPI usage
Hospitalized
Hx of CDI
GI surgery
Gram-positive, spore-forming bacteria
Diagnosis
3 or more loose stools in 24 hrs
Watery, non-bloody, +/- fever, abdominal pain, leukocytosis
Lab diagnostics
Stool culture
PCR
Toxin assay
ELISA
Endoscopy-- reserved for select cases
Pathophysiology
Interruption of normal flora
Colonization of C.diff
Toxins A & B
Inflammation, tissue damage, diarrhea
Fecal-oral transmission of spores