Clostridium difficile Infection (CDI)

Clostridium difficile Infection (CDI)


  • Acute onset of diarrhea (≥3 unformed stools in 24 hours)


  • Documented toxigenic C. difficile or toxin presence with no other cause for diarrhea (e.g. laxatives)
  • Do not send stool for testing if diarrhea not present or ileus

    • Toxin testing cannot be reliably performed
  • Testing is restricted to one specimen within 7 days due to enhanced detection methods

  • Toxin testing is NOT a test of cure, and should not be repeated to document resolution of disease

Treatment Principles

  • If antibiotics required: use shortest recommended duration and most targeted therapy for the organism

  • Prolonging the duration of CDI treatment until antibiotic regimens have been completed has no known benefit

  • Efficacy of IV metronidazole monotherapy is not well established

  • NO efficacy of IV vancomycin for CDI

Probiotics and prophylactic oral vancomycin not recommended for prevention of C. difficile based on limited evidence

Avoid anti-peristaltic agents (loperamide, Lomotil®, etc.) and anion-exchange resins (cholestyramine, colestipol)

Treatment - Initial Episodes

Treatment - Recurrent Disease

More Information

2021 Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) guidelines for CDI. Clin Infect Dis 2021.