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__NOTOC__
<div style="width: 1px; height: 1px; background-color: #999999; position: fixed; top: 10px; left: 10px"></div><div style="-webkit-user-select: none;"><div style="width: 75%;">
 
{| class="infobox" style="border: 0; float: right; width: 24%; position: fixed; top: 173px; right: 14px; background: #104E8B; border-radius: 10px 10px 10px 10px; margin: 0 0 0 0; padding: 5px 5px; font-weight: bold;"
{{CMG}}; {{AE}} {{GRN}}
| style="text-align: center; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); font-size: 120%;" | [[{{PAGENAME}}#Overview|{{fontcolor|#F8F8FF|TITLE}}]]
==Principles of Therapy for ''Clostridium difficile'' infection==
#If a patient has a strong pre-test probability for CDI, empiric therapy should be considered regardless of the laboratory testing result<ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 |pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref>. CDI accounts for about 20% of antibiotic-associated diarrhoea cases in the USA<ref name="Planche2013">{{cite journal|last1=Planche|first1=Tim|title=Clostridium difficile|journal=Medicine|volume=41|issue=11|year=2013|pages=654–657|issn=13573039|doi=10.1016/j.mpmed.2013.08.003}}</ref>.The main risk factors for CDI are:
##Antibiotic exposure and the first three months after cessation of antibiotics<ref name="pmid22146873">{{cite journal| author=Hensgens MP, Goorhuis A, Dekkers OM, Kuijper EJ| title=Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 3 | pages= 742-8 | pmid=22146873 | doi=10.1093/jac/dkr508 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22146873  }} </ref>. Commonly [[clindamycin]], [[penicillins]], [[cephalosporins]], [[fluoroquinolones]],and multiple antibiotics<ref name="KnightSurawicz2013">{{cite journal|last1=Knight|first1=Christopher L.|last2=Surawicz|first2=Christina M.|title=Clostridium difficile Infection|journal=Medical Clinics of North America|volume=97|issue=4|year=2013|pages=523–536|issn=00257125|doi=10.1016/j.mcna.2013.02.003}}</ref>.
##Exposure to '''''Clostridium difficile''''': up to 25% of hospitalized patients and residents of lonf term facilities are colonized<ref name="Planche2013">{{cite journal|last1=Planche|first1=Tim|title=Clostridium difficile|journal=Medicine|volume=41|issue=11|year=2013|pages=654–657|issn=13573039|doi=10.1016/j.mpmed.2013.08.003}}</ref>.
##Age >65<ref name="KnightSurawicz2013">{{cite journal|last1=Knight|first1=Christopher L.|last2=Surawicz|first2=Christina M.|title=Clostridium difficile Infection|journal=Medical Clinics of North America|volume=97|issue=4|year=2013|pages=523–536|issn=00257125|doi=10.1016/j.mcna.2013.02.003}}</ref>.
##History of [[inflammatory bowel disease]]<ref name="KnightSurawicz2013">{{cite journal|last1=Knight|first1=Christopher L.|last2=Surawicz|first2=Christina M.|title=Clostridium difficile Infection|journal=Medical Clinics of North America|volume=97|issue=4|year=2013|pages=523–536|issn=00257125|doi=10.1016/j.mcna.2013.02.003}}</ref>.
#Any antimicrobial agent should be discontinued<ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. |journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 | pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref>.
#Current guidelines recommend to choose the treatment regimen based on the severity of the disease<ref name="pmid20307191">{{cite journal|author=Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC et al.| title=Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). |journal=Infect Control Hosp Epidemiol | year= 2010 | volume= 31 | issue= 5 | pages= 431-55 | pmid=20307191 | doi=10.1086/651706 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20307191  }} </ref> <ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 |pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref><ref name="Planche2013">{{cite journal|last1=Planche|first1=Tim|title=Clostridium difficile|journal=Medicine|volume=41|issue=11|year=2013|pages=654–657|issn=13573039|doi=10.1016/j.mpmed.2013.08.003}}</ref><ref name="KnightSurawicz2013">{{cite journal|last1=Knight|first1=Christopher L.|last2=Surawicz|first2=Christina M.|title=Clostridium difficile Infection|journal=Medical Clinics of North America|volume=97|issue=4|year=2013|pages=523–536|issn=00257125|doi=10.1016/j.mcna.2013.02.003}}</ref>:
##Mild: diarrhea as the only symptom.
##Moderate:  raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline.
##Severe: leucocytosis >15,000 cells/mL OR serum creatinene level >1.5 times baseline or  abdominal tenderness and serum albumin < 3 g/dL.
##Severe complicated: hypotension or shock, ileus, megacolon, leucocytosis >20,000 cells/mL OR leucopenia <2,000, lactate >2.2 mmol/L, delirium, fever ≥ 38.5 °C, organ failure.
#Duration: recommendations stablish a 10-14 days treatment. If clinical response in 5-7 days, complete 10 days<ref name="KnightSurawicz2013">{{cite journal|last1=Knight|first1=Christopher L.|last2=Surawicz|first2=Christina M.|title=Clostridium difficile Infection|journal=Medical Clinics of North America|volume=97|issue=4|year=2013|pages=523–536|issn=00257125|doi=10.1016/j.mcna.2013.02.003}}</ref>.
#Do not use metronidazole beyond the first recurrence episode of CDI or for long-term therapy because of the risk of neurotoxicity<ref name="pmid20307191">{{cite journal|author=Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC et al.| title=Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). |journal=Infect Control Hosp Epidemiol | year= 2010 | volume= 31 | issue= 5 | pages= 431-55 | pmid=20307191 | doi=10.1086/651706 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20307191  }} </ref>.
#For mild-to-moderate patients who are intolerant/allergic to metronidazole and for pregnant/breastfeeding women, vancomycin should be used at standard dosing<ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 |volume= 108 | issue= 4 | pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref>.
#The use of anti-peristaltic agents to control diarrhea from confirmed or suspected CDI should be limited or avoided<ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 | pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref>.
#Supportive care should be delivered to all patients with severe or severe complicated CDI<ref name="pmid23439232">{{cite journal|author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 | pages= 478-98; quiz 499 |pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref>.
#CT scanning of the abdomen and pelvis is recommended in patients with severe complicated CDI<ref name="pmid23439232">{{cite journal|author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 | pages= 478-98; quiz 499 |pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref>.
#Surgical consult should be obtained in all patients with complicated CDI<ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 | pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }}</ref>.
#If there is a third recurrence after a pulsed vancomycin regimen, fecal microbiota transplant should be considered<ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 | pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref>.
 
==Medical Therapy==
<font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font><ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 |pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref><ref name="pmid20307191">{{cite journal|author=Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC et al.| title=Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). |journal=Infect Control Hosp Epidemiol | year= 2010 | volume= 31 | issue= 5 | pages= 431-55 | pmid=20307191 | doi=10.1086/651706 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20307191  }} </ref><ref name="Planche2013">{{cite journal|last1=Planche|first1=Tim|title=Clostridium difficile|journal=Medicine|volume=41|issue=11|year=2013|pages=654–657|issn=13573039|doi=10.1016/j.mpmed.2013.08.003}}</ref><ref name="KnightSurawicz2013">{{cite journal|last1=Knight|first1=Christopher L.|last2=Surawicz|first2=Christina M.|title=Clostridium difficile Infection|journal=Medical Clinics of North America|volume=97|issue=4|year=2013|pages=523–536|issn=00257125|doi=10.1016/j.mcna.2013.02.003}}</ref><ref name="pmid18971494">{{cite journal| author=Kelly CP, LaMont JT| title=Clostridium difficile--more difficult than ever. | journal=N Engl J Med |year= 2008 | volume= 359 | issue= 18 | pages= 1932-40 | pmid=18971494 | doi=10.1056/NEJMra0707500 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18971494  }} </ref>
{|
 
| valign=top |
 
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<font color="#FFF">
 
'''Initial episode'''
 
</font>
 
</div>
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
 
<font color="#FFF">
 
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Mild to moderate'''
 
</font>
 
</div>
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
 
<font color="#FFF">
 
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Severe'''
 
</font>
 
</div>
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
 
<font color="#FFF">
 
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Severe complicated'''
 
</font>
 
</div>
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
 
<font color="#FFF">
 
'''Recurrence'''
 
</font>
 
</div>
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
 
<font color="#FFF">
 
&nbsp;&nbsp;▸&nbsp;&nbsp;'''First recurrence'''
 
</font>
 
</div>
<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
 
<font color="#FFF">
 
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Second recurrence'''
 
</font>
 
</div>
| valign=top |
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
 
| valign=top |
 
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
 
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center| {{fontcolor|#FFF|Mild to moderate}}
 
|-
|-
 
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Recommended treatment'''''
[[{{PAGENAME}}#Diagnostic Criteria|{{fontcolor|#F8F8FF|Diagnostic Criteria}}]]
 
|-
|-
 
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg orally q8h'''''
[[{{PAGENAME}}#Classification|{{fontcolor|#F8F8FF|Classification}}]]
 
|-
|-
 
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''If no improvement in 5-7 days'''''
[[{{PAGENAME}}#Causes|{{fontcolor|#F8F8FF|Causes}}]]
 
|-
|-
 
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 125 mg orally q6h'''''
[[{{PAGENAME}}#Focused Initial Rapid Evaluation|{{fontcolor|#F8F8FF|Focused Initial Rapid Evaluation}}]]
 
|-
|-
 
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
|}
[[{{PAGENAME}}#Complete Diagnostic Approach|{{fontcolor|#F8F8FF|Complete Diagnostic Approach}}]]
 
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
 
| valign=top |
 
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
 
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center| {{fontcolor|#FFF|Severe}}
 
|-
|-
 
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Recommended treatment'''''
[[{{PAGENAME}}#Management|{{fontcolor|#F8F8FF|Management}}]]
 
|-
 
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 125 mg orally q6h'''''
 
|-
|-
 
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
|}
[[{{PAGENAME}}#Dos and Don'ts|{{fontcolor|#F8F8FF|Dos and Don'ts}}]]
 
|}
|}
__NOTOC__
{{CMG}}


{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
==Overview==  


| valign=top |
==Diagnostic Criteria==


{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
==Classification==


! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center| {{fontcolor|#FFF|Severe complicated}}
==Causes==


|-
===Life Threatening Causes===
<span style="font-size: 85%;">Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.</span>


| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Recommended treatment'''''<sup>†</sup>
===Common Causes===


|-
==Focused Initial Rapid Evaluation==
<span style="font-size: 85%;">
'''Abbreviations''':
CBC, complete blood count;
DC, differential count;
ICU, intensive care unit;
INR, international normalized ratio;
LFT, liver function test;
PT, prothrombin time;
PTT, partial prothrombin time;
SaO2, arterial oxygen saturation;
ScvO2, central venous oxygen saturation;
SvO2, mixed venous oxygen saturation;
SMA-7, sequential multiple analysis-7.
</span>


| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 500 mg orally q6h'''''
{{Familytree/start}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Disease Suspected==
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Immediate Treatment==
</div>}}
{{Familytree/end}}


|-
==Complete Diagnostic Approach==
<span style="font-size: 85%;">
'''Abbreviations''':
CBC, complete blood count;
DC, differential count.
</span>


| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
{{Familytree/start}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Focused History==
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Physical Examination==
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Laboratory Workup==
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Imaging Study==
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Other Investigation==
</div>}}
{{Familytree/end}}
</div>


|-
==Management==


| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg IV q8h'''''
==Dos and Don'ts==


|-
===Dos===


| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> If '''''[[ileus]]''''' present, add'''''[[Vancomycin]] 500 mg in 100 mL NS per rectum q6h as retention enema'''''.</SMALL>
===Don'ts===


|-
==Guidelines==
 
|}
 
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
 
| valign=top |
 
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
 
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center| {{fontcolor|#FFF|First recurrence}}
 
|-
 
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | Recommended treatment'''''
 
|-
 
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''Same as first episode but stratified by severity'''''
 
|-
 
|}
 
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
 
| valign=top |
 
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
 
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center| {{fontcolor|#FFF|Second recurrence}}
 
|-
 
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Recommended treatment'''''
 
|-
 
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] in tapered and pulsed doses'''''
 
      125 mg 4 times daily for 14 days
 
      125 mg 2 times daily for 7 days
 
      125 mg once daily for 7 days
 
      125 mg once every 2 days for 8 days (4 doses)
 
      125 mg once every 3 days for 15 days (5 doses)
 
|-
 
|}
 
|}
 
|}


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
[[Category:Disease]]
[[Category:Medicine]]
[[Category:Resident survival guide]]

Latest revision as of 13:26, 30 April 2015

TITLE

Diagnostic Criteria

Classification

Causes

Focused Initial Rapid Evaluation

Complete Diagnostic Approach

Management

Dos and Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Diagnostic Criteria

Classification

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Focused Initial Rapid Evaluation

Abbreviations: CBC, complete blood count; DC, differential count; ICU, intensive care unit; INR, international normalized ratio; LFT, liver function test; PT, prothrombin time; PTT, partial prothrombin time; SaO2, arterial oxygen saturation; ScvO2, central venous oxygen saturation; SvO2, mixed venous oxygen saturation; SMA-7, sequential multiple analysis-7.

Disease Suspected

 
 
 
 
 
 
 
 

Immediate Treatment

 
 

Complete Diagnostic Approach

Abbreviations: CBC, complete blood count; DC, differential count.

Focused History

 
 
 
 
 
 
 
 

Physical Examination

 
 
 
 
 
 
 
 

Laboratory Workup

 
 
 
 
 
 
 
 

Imaging Study

 
 
 
 
 
 
 
 

Other Investigation

 
 

Management

Dos and Don'ts

Dos

Don'ts

Guidelines

References

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