Clostridioides difficile

Clostridioides difficile


Contact/Spore Precautions


General Information

Vancomycin 125 mg PO QID

Risk factors for recurrent disease Fidaxomicin 200 mg PO BID

Severe disease (toxic megacolon in ICU) Vancomycin 500 mg PO q6h PLUS Metronidazole 500 mg IV q8h

Anaerobic spore forming gram positive bacilli, box-car shaped

Nosocomial more common than community onset diarrhea usually after taking antibiotics.

Can occur in outbreaks.

Recurrence is very common therefore previous history of C. difficile is a risk factor.

Antacids, especially proton-pump inhibitors, and chemotherapy also increase risk.

Wide range of symptoms possible.

  • Profuse, watery diarrhea.
  • Pseudomembranous colitis or toxic megacolon.

General treatment duration 10 days. May be longer in poor responders or patients on concomitant antibiotics.

Cholestyramine may bind other oral medication (ie PO vanco). Not recommended.

Metronidazole no longer recommended first line by IDSA guidelines.

In refractory cases, fecal microbiota transplants have been effective. Rebyota is an FDA-approved live biotherapeutic enema approved for recurrent CDI prevention.