Recommendations
| Дозування | Ремарки | |
|---|---|---|
|
vancomycin oral 250 mg 4 times daily for 10 days
or vancomycin oral 125 mg 4 times daily for 10 days |
SWAB remarks First uncomplicated CDI in a non-ambulatory patient |
|
|
fidaxomicin oral 200 mg twice daily for 10 days
|
SWAB remarks Vulnerable patient* (see below) or concurrent use of other antibiotics |
|
|
metronidazole oral 500 mg three times daily for 10 days
|
SWAB remarks Only ambulatory, non-vulnerable patient |
| Дозування | Ремарки | |
|---|---|---|
|
vancomycin oral 250 mg 4 times daily for 10 days
|
||
|
vancomycin oral min. 250 mg / max. 500 mg 4 times daily
|
SWAB remarks If oral treatment is not possible: vancomycin infusion solution via a duodenal tube (250 mg) and/or by enema (500 mg) |
|
|
metronidazole IV 500 mg three times daily
or tigecycline IV loading dose 100 mg, 50 mg twice daily |
SWAB remarks When it is uncertain whether orally administered therapy can reach the colon, for example in ileus SWABID (National) remarks add metronidazole or tigecycline to oral therapy |
Stop the responsible antibiotic if possible, and isolate the patient.
Dose: vancomycin capsules oral 4 x 250 mg; a 4 x 125 mg suspension is preferred but is not available in the Netherlands; consider local preparation in consultation with the pharmacy.
* Vulnerable patient groups for whom recurrent CDI can have seriously morbid or otherwise disruptive consequences:
1. Patients undergoing intensive medical treatment (e.g. haemodialysis, (planned) chemotherapy).
2. Immunocompromised persons.
3. Prolonged admission or residence in a nursing home.
For severe, severely complicated, or therapy-refractory CDI: consult the surgeon at an early stage. See the SWAB guideline for further information.
Severe CDI: An infection is designated 'severe CDI' when systemic manifestations occur in addition to diarrhoea. These manifestations may include: fever (core body temperature >38°C), significant leukocytosis (>15 × 109/l), and an increase in serum creatinine (>50% above baseline). Other signs of severe CDI are: colonic dilatation on imaging, pericolonic fat stranding, and colonic wall thickening.
Severely complicated or fulminant CDI: This disease state is defined by the presence of one of the following signs of illness attributable to CDI: hypotension, septic shock, an elevated serum lactate concentration, ileus, toxic megacolon, bowel perforation or a rapid deterioration of the patient (fulminant course).
Therapy-refractory CDI: Severe or severely complicated CDI that does not clinically improve after 3-5 days of the recommended anti-CDI antibiotic therapy.
For advice regarding possible faecal transplantation and surgical management see the SWAB guideline Acute diarrhoea.