This protocol covers the management of toxic megacolon arising from fulminant Clostridioides difficile infection — a severe presentation defined by markedly elevated white blood cell count alongside haemodynamic instability or end-organ compromise.
Fulminant Clostridioides difficile infection with leukocytosis greater than 15 × 10³/µL, accompanied by at least one of: shock, sepsis, multiorgan failure, ileus, or megacolon. This constitutes severe complicated disease requiring urgent structured intervention.
The initial step is antibiotic stewardship — addressing the inciting cause — combined with immediate resuscitation for shock. A targeted antibiotic regimen is then initiated, with additional delivery strategies available for cases where ileus is present or likely. The complete structured protocol is accessible below.
Response to medical therapy with resolution of shock and a declining white blood cell count.