Clostridium difficile enterocolitis

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Clostridium difficile enterocolitis

Management

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) but:
  • 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 above, consider:

  • 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