CDI Treatment

INITIAL EPISODE

Mild to Moderate:

metronidazole 500mg PO q8h x10 – 14 days

If symptoms not resolving in 72 hours (i.e. febrile, increase WBC, increase Scr, increased loose stools):

  • switch to vancomycin 125mg PO q6h to complete 14 day course

Severe:

vancomycin 125mg PO q6h x10 – 14 days

Severe with complications:

metronidazole 500mg IV q8h + vancomycin 125mg PO q6h x14 days

FIRST RECURRENCE

Stratify patient by disease severity and choose treatment as per regimens in initial episodes of CDI.

SECOND OR MORE RECURRENCE

1.  Consult Infectious Diseases

2.  Consider starting:

vancomycin 125mg PO q6h x14 days THEN taper regimen of:

  • vancomycin 125mg PO BID x 7 days, then
  • vancomyin 125mg PO daily x7 days, then
  • vancomycin 125mg PO q2days x 7 days, then
  • vancomycin 125mg PO q3days x 15 days, then
  • stop

3.  Consider adding probiotics:

  • Saccharomyces boulardii 500mg PO BID x 28 days; start on day 14 of vancomycin treatment if patient does not have immunosuppresion, implanted grafts or vascular devices or active inflammatory bowel disease

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