C. diff Colitis

  • CC: Diarrhea, abdominal pain

  • PP: Recent antibiotics, fever, N/V

  • PN: Usually no GI bleed unless severe

  • pertinent SHx: Recent hospitalization/SNF

  • Etiology: C. diff toxin-mediated colitis

  • risk factors: Antibiotics, PPI use, hospitalization, immunosuppression

  • initial DATA:

    • WBC↑

    • Cr↑/AKI possible

    • Stool PCR/toxin+

  • pending DATA:

    • CT A/P if fulminant concern

    • Lactate if septic/hemodynamically unstable

  • MEDS: Home meds, recent antibiotics, immunosuppression, anticoagulation

  • COURSE: Monitor stool output, abdominal exam, hemodynamics

Plan

  • Contact/enteric isolation

  • Stop offending antibiotics if possible

  • Avoid antimotility agents

  • IVF + lyte repletion PRN

  • Trend CBC/Cr/abdominal exam

  • Surgery consult if toxic megacolon, perforation, ileus, worsening shock

Antibiotics

  • Initial/non-fulminant:

    • Vancomycin 125 mg PO QID x10 days

    • OR Fidaxomicin 200 mg PO BID x10 days

  • Fulminant:

    • Vancomycin 500 mg PO/NG QID

    • PLUS Metronidazole 500 mg IV q8h

    • Add rectal vancomycin if ileus

Notes

  • IV antibiotics alone are NOT adequate

  • PO vancomycin/fidaxomicin required for colonic treatment

  • Severe/fulminant cases may need 10–14 days treatment