This handout is for clostridioides difficile infection. Your care team identified this based on: ≥3 unformed stools in 24h with recent antibiotic / healthcare exposure (idsa/shea 2021).
Other reasons your team may use this plan: positive stool c. difficile test (naat + toxin or toxin eia per idsa/shea 2021); recent antibiotic exposure within 8 weeks + new diarrhea (idsa/shea 2021); pseudomembranes seen on endoscopy.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| fidaxomicin | 200 mg PO BID x 10 days | PO | BID | IDSA/SHEA 2021 — fidaxomicin preferred (lower recurrence vs vancomycin; Louie 2011 NEJM PMID 21288078 non-inferior cure with lower 25-week recurrence) |
| vancomycin | 125 mg PO QID x 10 days | PO | QID | IDSA/SHEA 2021 — oral vancomycin equally acceptable first-line; lower cost |
| metronidazole | 500 mg PO TID x 10 days | PO | TID | IDSA/SHEA 2021 — metronidazole NO LONGER preferred and only when fidaxomicin and vancomycin unavailable |
Plan: C. difficile infection — severity-driven antibiotic + recurrence prevention (IDSA/SHEA 2021 focused update)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Total 10-day fidaxomicin or vancomycin course; bezlotoxumab single infusion during antibiotic course (≥1 recurrence-risk feature) (IDSA/SHEA 2021); fecal microbiota live (Rebyota) or FMT for recurrent CDI; avoid re-exposure; PPI deprescribing if possible
Guideline: IDSA/SHEA 2021 Focused Update: Clinical Practice Guideline on Management of C. difficile Infection in Adults