A lot has changed in the diagnosis and treatment of Clostridium Difficile Infection (CDI) since the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) last published guidelines in 2010.
The new guidelines recommend the development of an antibiotic stewardship program, which should focus on reducing the frequency and duration of the use of high-risk antibiotics. Specifically, restriction of fluoroquinolones, clindamycin, and cephalosporins (except for surgical antibiotic prophylaxis) should be considered.
Although probiotics are commonly seen during the treatment of CDI, the current guidelines state that there is insufficient data to support this practice at this time.
Treatment should begin with discontinuing the offending antibiotic. For fulminant CDI or cases where a substantial delay in laboratory confirmation is expected, empiric antibiotic therapy is recommended.
The best treatment for an initial CDI episode is either vancomycin or fidaxomicin. The recommended dosage of vancomycin is 125 mg orally 4 times per day and for fidaxomicin, 200 mg twice daily for 10 days.
Metronidazole is not recommended as first-line treatment, but can be used when the above agents are unavailable. The recommended dosage is 500 mg orally 3 times per day for 10 days. Repeated or prolonged courses should be avoided due to risk of cumulative and potentially irreversible neurotoxicity
ACTION ITEM: Are you sharing new antibiotic starts with your consultant pharmacist? Is your pharmacist making recommendations to guide antibiotic stewardship and guideline adherence?
How we can help
Let us review your antibiotic stewardship program and usage patterns. If you don’t have a program, let us develop it and teach you how to use it.