C. diff Flashcards
Recommend against probiotics for the prevention or C diff in patients being treated w/ abx
conditional, moderate evidence
Recommend against probiotics for the prevention of CDI recurrence
strong, very low evidence
CDI testing algorithms should include both a highly sensitive and a highly specific testing modality to help distinguish colonization from active infection
conditional, low evidence
Recommend PO vanc 125mg QID for 10 days be used to treat initial episode of non-severe CDI
strong, low evidence
Recommend PO fidaxomicin 200mg BID for 10 days be used to treat initial episode of non-severe CDI
strong, moderate evidence
Oral flagyl 500mg TID for 10 days may be considered for treatment of initial non-severe CDI
strong, moderate evidence
As initial therapy for severe CDI, we recommend vanc 125mg QID for 10 days
strong, low evidence
As initial therapy for severe CDI, we recommend fidaxomicin 200mg BID for 10 days
strong, very low evidence
Patient w/ fulminant CDI should receive adequate volume resuscitation and treatment w/ 500mg of PO vanc q6h (strong, very low) for the first 48-72 hrs. Combination w/ IV flagyl 500mg q8 hr can be considered
conditional, low evidence
For patients w/ an ileus, the addition of vanc enemas may be beneficial
conditional, very low evidence
Suggest FMT consideration for patients w/ severe and fulminant CDI refractory to avi therapy, especially when poor surgical candidates
strong, low evidence
Suggest tapering/pulsed dose vanc for patient w/ first recurrence after an initial course of fidaxomicin, vanc, or flagyl
strong, very low evidence
Recommend fidaxomicin for patient w/ first recurrent after an initial course of fidaxomicin, vanc, or flagyl
conditional, moderate evidence
Recommend patients experiencing their second or further recurrence of CDI be treated w/ FMT to prevent further recurrences
strong, moderate evidence
Recommend FMT be delivered through colonoscopy (strong, moderate evidence) or capsules (strong, moderate evidence) for treatment of rCDI, we suggest delivery by enema if other methods are unavailable (conditional, low evidence)
see front
Suggest repeat FMT for patients w/ a recurrence within 8wks of an initial FMT
conditional, very low evidence
For patients with rCDI who are not candidates for FMT, who relapsed after FMT, or who require ongoing or frequent courses of antibiotics, suppressive PO vanc may be used as prevention
conditional, very low evidence
PO vanc ppx may be considered during subsequent systemic antibiotic use in patients w/ a hx of CDI who are at high risk of recurrence to prevent further recurrence
conditional, low evidence
Suggest bezlotoxumab be considered for prevention of CDI recurrence in patients who are at high risk of recurrence
conditional, moderate evidence
Suggest against discontinuation of anti secretory therapy in patients w/ CDI, provided there is an appropriate indication for their use
strong, very low evidence
Recommend C diff testing in patients w/ IBD presenting w/ acute flare associated w/ diarrhea
strong, low evidence
Suggest vanc 125mg PO QID for a minimum of 14 days in patients w/ IBD and CDI
strong, very low evidence
FMT should be considered for recurrent CDI in patients w/ IBD
strong, very low evidence
