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

Treatment of Severe Clostridioides difficile Infection with White Blood Cell Count ≥15,000 cells/mm³

Severe Clostridioides difficile infection (CDI) is identified at diagnosis when specific laboratory thresholds are met — namely a white blood cell (WBC) count of 15,000 cells/mm³ or higher, or a serum creatinine above 1.5 mg/dL. These findings predict unfavourable outcomes and determine the treatment path from the outset.

Clinical scenario

This protocol applies to patients diagnosed with CDI who present with an elevated WBC (≥15,000 cells/mm³) or elevated serum creatinine (>1.5 mg/dL) — laboratory markers used to classify the infection as severe at the time of diagnosis.

Treatment approach (partial overview)

First-line therapy for severe CDI involves targeted antibiotic therapy with an established CDI-specific agent. Selection between available options and full dosing guidance are provided in the complete structured protocol.

Full regimen, drug selection criteria, and duration are available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.14309/ajg.0000000000001278

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.

As initial therapy for severe CDI, we recommend vancomycin 125 mg 4 times a day for 10 days (strong recommendation, low quality of evidence).

As initial therapy for severe CDI, we recommend fidaxomicin 200 mg twice daily for 10 days (conditional recommendation, very low quality of evidence).

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