Guidelines
First Recurrence

First Recurrence

ID Consult

Consider ID consult if risk factors for recurrence are present (age ≥ 65, immunocompromised, severe CDI, chronic PPI use) so patient can be assessed for ambulatory bezlotoxumab referral (restricted to ID)

Definitions

WBC ≥15 and/or Scr >1.5 mg/dL (or ≥1.5x baseline if pre-morbid baseline ≥ 1.5)

Presence of hypotension, shock, lactic acidosis, and/or evidence of Ileus, bowel obstruction, perforation, or signs of toxic megacolon

Treatment by Severity

  • Fidaxomicin Extended-Pulsed 200 mg PO BID x 5 days, followed by 200 mg PO QOD x 20 days (10 doses), OR
  • Fidaxomicin 200 mg PO BID x 10 days, OR
  • Vancomycin PO Taper

Note:

  • Consider extended-pulsed regimen unless compliance following discharge is a concern
  • Consider a vancomycin taper in the setting of previous fidaxomicin failure or access/cost issues
  • It will take several business days to determine if copay assistance is available. If selecting fidaxomicin, consider sending a prescription to Specialty pharmacy upon initiation of therapy to begin processing. Search ‘fidaxomicin’ on Point MultiCare for detailed instructions. Fidaxomicin (Dificid) Specialty Rx Instructions
  • Vancomycin 500 mg PO q6h plus metronidazole 500 mg IV q8h
  • Rectal vancomycin (add if concern for ileus)

Medication Information