Clostridium difficile infection
ICD-10 A04.7 · ICD-11 1A04

Treatment of Initial Non-Severe Clostridioides difficile Infection — WBC Below 15,000 cells/mm³ and Creatinine ≤ 1.5 mg/dL

This protocol covers first-line management of an initial episode of Clostridioides difficile infection classified as non-severe based on laboratory thresholds at the time of diagnosis.

Clinical Scenario

Non-severe CDI is defined by an initial episode meeting both of the following criteria — values below which the infection is not classified as severe:

WBC < 15,000 cells/mm³ Serum creatinine ≤ 1.5 mg/dL
Treatment Approach

Management of this non-severe initial episode centres on oral antibiotic therapy. The preferred agent is determined by patient risk profile. The complete regimen, agent selection criteria, and sequencing are available in the full protocol.

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References

  1. We recommend the following criteria, which are predictive of unfavorable outcomes, be used to classify severe C. difficile infection at the time of diagnosis: white blood cell (WBC) ≥15,000 cells/mm³ or serum creatinine >1.5 mg/dL.
  2. We recommend that oral vancomycin 125 mg 4 times daily for 10 days be used to treat an initial episode of nonsevere CDI (strong recommendation, low quality of evidence).
  3. We recommend that oral fidaxomicin 200 mg twice daily for 10 days be used for an initial episode of nonsevere CDI (strong recommendation, moderate quality of evidence).
  4. Oral metronidazole 500 mg 3 times daily for 10 days may be considered for treatment of an initial nonsevere CDI in low-risk patients (strong recommendation/moderate quality of evidence).

DOI: 10.14309/ajg.0000000000001278

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