Clostridioides difficile infection management in adults – guideline update
The GGC Clostridioides difficile guideline has been updated to reflect changes to the NICE guideline [NG199] Clostridioides difficile infection: antimicrobial prescribing.
The main changes are:
- The name of the guideline has changed to Suspected or Proven Clostridioides difficile Infection Management in Adults. The bacteria species name was changed from Clostridium to Clostridioides in 2016.
- Severity markers are not used to decide initial therapy. First line treatment for Clostridioides difficile (unless ileus/ colonic dilatation) has changed from metronidazole to oral vancomycin 125mg 6 hourly (duration 10 days).
- If ileus/colonic dilatation -Discuss with the on call surgical team and start oral vancomycin 500mg 6 hourly PLUS IV metronidazole 500mg 8 hourly (duration 10 days. IV metronidazole should be stopped when ileus resolved).
- Oral fidaxomicin 200mg 12 hourly (duration 10 days) has been added as second line therapy. Discuss second line treatment and recurrence with microbiology.
Refer to the guideline for full details including information on how to give vancomycin or fidaxomicin if swallowing difficulties or nil by mouth.
Written by NHSGGC Antimicrobial Pharmacy Team in collaboration with Communications subcommittee of ADTC.
Published: 12/10/2022. Medicines Update blogs are correct at the time of publishing