Antimicrobial prescribing: NHS Forth Valley
Important: Therapy
Vancomycin 125mg PO 6 hourly
If any features of life-threatening infection (see definitions in Notes below) - seek urgent surgical review
Notes:
Treatment duration: 10 days
C difficile infection (CDI)
Important: Therapy
Discuss with an infection specialist.
Notes:
Second line options include:
- Oral Fidaxomicin
- High-dose oral Vancomycin (500mg) with or without IV Metronidazole
If any features of life-threatening infection (see definitions in Notes below) - seek urgent surgical review
Important: Therapy
Fidaxomicin 200mg PO 12 hourly
If treatment failure identified as incomplete initial treatment course, then retreat as per 1st line treatment
Notes:
Important: Therapy
Vancomycin 125mg PO 6 hourly
(i.e. as per 1st line treatment)
Notes:
Treatment duration: 10 days
Important: Therapy
Discuss with infection specialist
Notes:
Options include:
- Faecal Microbiota Transplant (FMT)
- Tapering Vancomycin course
Important: Notes
Review existing antibiotic treatment and stop it unless essential. If an antibiotic is still essential, consider changing to one with a lower risk of causing C. difficile infection (e.g. non 4C antibiotics)
Review the need to continue any treatment with:
- proton pump inhibitors
- other medicines which effect GI activity or motility e.g. laxatives, loperamide
- medicines that may cause problems if people are dehydrated e.g. NSAIDs, ACE inhibitors, angiotensin‑2 receptor antagonists, diuretics.
If patients are unable to tolerate vancomycin capsules, the vials for injection can be used enterally.
- Add 10ml of Water for Injections to vials containing 500mg vancomycin powder. This gives a solution strength of 50mg/ml.
- For a dose of 125mg vancomycin, draw up 2.5ml of solution.
- For a dose of 500mg vancomycin, draw up 10ml of solution.
- Each dose should then be diluted with 30ml of sterile water (to minimise GI side effects. Fruit squash may also be used if unable to tolerate the taste).
- After ng administration, ng tube should be flushed with 10ml water.
- Vials are for single use only and any remaining volume should be disposed of immediately.
Definitions:
Diarrhoea - passage of three or more loose or liquid stools per day, or more frequently than is normal for the individual (i.e. in patients with chronic loose stools) The frequent passing of formed stools is not diarrhoea.
C difficile infection – diarrhoea with a C difficile toxin positive result.
C diff equivocal (GDH positive / C diff toxin negative result) - Usually reflects colonisation with C diff rather than infection, even in the presence of diarrhoea. Rarely, C diff equivocal results are found in stool from patients with very early genuine C diff infection, before detectable levels of toxin have accumulated. Recommend repeat stool sample if initial result equivocal and no alternative diagnosis made. Patients with two C diff equivocal results are highly unlikely to have C diff infection and diarrhoea is likely due to another cause, including alternative infectious pathogens so ensure final culture results reviewed.
Life-threatening CDI: CDI with any one of the following present: admission to ICU for CDI; hypotension with or without required use of vasopressors; ileus or significant abdominal distension; mental status changes, WBC ≥35 cells x 109 /L or <2 cells x 109 /L; serum lactate >2.2 mmol/l; end organ failure (mechanical ventilation, renal failure)