The metronidazole dosage is 500 mg intravenously every 8 hours.* Intravenously administered metronidazole should be administered together with oral or rectal vancomycin, particularly if ileus is present (strong recommendation, moderate quality of evidence). The vancomycin dosage is 500 mg orally 4 times per day and 500 mg in approximately 100 mL normal saline per rectum every 6 hours as a retention enema. If ileus is present, vancomycin can also be administered per rectum (weak recommendation, low quality of evidence). For fulminant CDI*, vancomycin administered orally is the regimen of choice (strong recommendation, moderate quality of evidence). FDX 200 mg given twice daily for 10 days, ORġ.VAN, 125 mg 4 times per day by mouth for 10 days followed by rifaximin 400 mg 3 times daily for 20 days, OR.VAN in a tapered and pulsed regimen, OR.FDX 200 mg given twice daily for 10 days if VAN was used for the initial episode.Use a prolonged tapered and pulsed VAN regimen if a standard regimen was used for the initial episode (eg, 125 mg 4 times per day for 10–14 days, 2 times per day for a week, once per day for a week, and then every 2 or 3 days for 2–8 weeks), OR.VAN 125 mg given 4 times daily for 10 days if metronidazole was used for the initial episode, OR.Strong/Moderate (oral VAN) Weak/Low (rectal VAN) Strong/Moderate (intravenous metronidazole) Intravenously administered metronidazole (500 mg every 8 hours) should be administered together with oral or rectal VAN, particularly if ileus is present. If ileus, consider adding rectal instillation of VAN. VAN, 500 mg 4 times per day by mouth or by nasogastric tube.FDX 200 mg given twice daily for 10 days.VAN, 125 mg 4 times per day by mouth for 10 days, OR.Leukocytosis with a white blood cell count of ≤15000 cells/mL and a serum creatinine level 1.5 mg/dL Strength of Recommendation/ Quality of Evidence The extent to which these guidelines can be implemented is impacted by the size of the institution and the resources, both financial and laboratory, available in the particular clinical setting.
A detailed description of the methods, background, and evidence summaries that support each of the recommendations can be found in the full text of the guidelines.
The panel followed a process used in the development of other Infectious Diseases Society of America (IDSA) guidelines, which included a systematic weighting of the strength of recommendation and quality of evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system ( Figure 1). In addition to diagnosis and management, recommended methods of infection control and environmental management of the pathogen are presented. difficile, or colonoscopic or histopathologic findings revealing pseudomembranous colitis. difficile toxins or detection of toxigenic C. CDI is defined by the presence of symptoms (usually diarrhea) and either a stool test positive for C. Summarized below are recommendations intended to improve the diagnosis and management of Clostridium difficile infection (CDI) in adults and children. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.
Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs.
difficile has established itself as an important community pathogen. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States.
The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis.
A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults.