Clostridium difficile enterocolitis
If feasible, discontinue other antimicrobials.
Keep the patient and family in isolation with barrier nursing
and separate tolilet facilities. Treat for 10 days with:
- oral/IV metronidazole (7.5 mg/kg/dose PO TDS max 400 mg).
For treatment failures, discuss with the Infectious Diseases
team. Consider adding:
- oral vancomycin (40 mg/kg/DAY TDS or QID max 2 g/DAY)
- adsorption of oral vancomycin is minimal but monitor levels in
patients with renal failure
- it risks selection of VRE (vancomycin resistant enterococci)
therefore use of vancomycin orally must first be discussed
with the Infectious Diseases team
- do not use with cholestyramine (binds vancomycin).
As many as 20% of patients experience recurrence after
discontinuation of therapy. In addition to antimicrobial therapy
- cholestyramine which binds the toxin and may relieve symptoms.
Dose is 4 g given 6 - 8 hourly. Beware - cholestyramine binds
vancomycin and other drugs.
Document last reviewed: December 2010