Sandbox sc

Clostridium difficile

• 1. Initial episode

• 1.1 Mild to moderate

• Preferred regimen: Metronidazole 500 mg orally q8h
• Alternative regimen(If no improvement in 5-7 days): Vancomycin 125 mg orally q6h

• 1.2 Severe

• Preferred regimen: Vancomycin 125 mg orally q6h

• 1.3 Severe complicated

• Preferred regimen: Vancomycin 500 mg orally q6h AND Metronidazole 500 mg IV q8h
• NOTE: If ileus present, add Vancomycin 500 mg in 100 mL normal saline per rectum q6h as retention enema

• 2.Recurrence

• 2.1 First recurrence

• preferred regimen: Same as first episode but stratified by severity

• 2.2 Second recurrence

• preferred regimen: Vancomycin 125 mg 4 times daily for 14 days or 125 mg 2 times daily for 7 days or 125 mg once daily for 7 days or 125 mg once every 2 days for 8 days (4 doses) or 125 mg once every 3 days for 15 days (5 doses)