C. Diff Cards

Question 1

What is the first-line treatment for initial mild-to-moderate C. diff infection?

Answer 1

Oral vancomycin 125 mg QID x 10 days or fidaxomicin 200 mg BID x 10 days.

Question 2

What is an alternative if vancomycin and fidaxomicin are unavailable?

Answer 2

Oral metronidazole 500 mg TID x 10 days (only if others not available).

Question 3

How is a first recurrence of C. diff treated?

Answer 3

Fidaxomicin or a pulsed-tapered vancomycin regimen.

Question 4

How is multiple recurrences of C. diff managed?

Answer 4

Fidaxomicin, vancomycin taper, or fecal microbiota transplant (FMT).

Question 5

How is severe C. diff defined and treated?

Answer 5

WBC ≥15,000 or Cr ≥1.5× baseline. Treat with oral vancomycin or fidaxomicin.

Question 6

How is fulminant C. diff (e.g., hypotension, ileus, megacolon) treated?

Answer 6

Oral vancomycin + IV metronidazole ± rectal vancomycin if ileus present. Consider surgery.

Question 7

What supportive care should be included in C. diff treatment?

Answer 7

Fluid and electrolyte replacement, avoid anti-motility agents (e.g., loperamide), isolate patient.

Question 8

What precautions are required for hospitalized C. diff patients?

Answer 8

Contact precautions with handwashing using soap and water (not alcohol-based sanitizer).