A patient on your ward is being treated with ceftriaxone for pneumonia. Two days after antibiotic administration, she begins to experience watery diarrhea, but no fever.Clostridium difficile PCR testing on a stool sample comes back positive. The patient’s CBC, lytes and creatinine are within normal limits.
- What is your initial treatment for this patient?
This patient has a mild C. difficile infection.
The treatment indicated is Metronidazole 500mg PO TID for 10-14days.
Second line treatment is Vancomycin 125mg PO QID for 10-14days.
- How would your management change if the patient developed a fever, an elevated WBC count, and hypotension?
A patient with C. difficile presenting with fever, an elevated WBC count, and hypotension is exhibiting severe/complicated C. difficile infection.
The treatment in this case would be metronidazole 500mg IV q8h AND vancomycin 125-500mg PO QID.
Bagdasarian N, Rao K and Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systemic review. JAMA. 2015;313:398-408.