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C difficile diagnosis and treatment

Description: C diff diarrhea Epic smart phrase, including basic 2010 IDSA guideline recommendations on treatment with flagyl and vancomycin.

Diagnosis of C difficile diarrhea:

  • 3 or more unformed stools in 24 or fewer consecutive hours
  • Positive test C. difficile and its toxins (conducted on unformed, diarrheal stool sample - only exception is suspected ileus).

Treatment:

  • Stop inciting antimicrobial therapy (all agents in the same class) ***.
  • Avoid probiotic (lack of clinical data and the potential risk of blood stream infection) and antiperistaltic agents (might interfere with symptoms of infection; might increase the risk of toxic megacolon).
  • @BRIEFLAB(WBC)@ ***> or <*** 15
  • @BRIEFLAB(creat)@ ***> or <*** 1.5xbaseline Cr of ***
  • Treat with:
    • If first episode, WBC<15 and Cr<1.5x baseline (mild-moderate disease) then Metronidazole 500 mg PO TID 10-14 days
    • If first episode, WBC>15 or Cr>1.5x baseline (sever disease) then vancomycin 125mg QID PO 10-14 days
    • If first episode with hypotension, shock, ileus or megacolon then vancomycin 500mg QID PO/NGT plus metronidazole 500 mg IV Q8h. Consider vancomycin per rectum with ileus or ostomy.
    • First recurrence, treat same as first episode
    • Second recurrence, use vancomycin PO in a tapered or pulsed regimen

References:

1. Cohen SH et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010; 31(5):000-000.

2. Gerding, DN et al. Treatment of Clostridium difficile Infection. Clin Infect Dis 2008; 46:S-32-42.

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