Clostridium difficile infection (CDI)

Introduction

Clostridium difficile infection (CDI) is a significant complication of antibiotic therapy and may be life-threatening. Any patient diagnosed with CDI requires prompt assessment, severity scoring and treatment.

Local guidance on diagnosis and management of CDI (link only active if accessing via NHS network), including a severity assessment sheet for use in hospital, is provided on the Infection Prevention and Control site.

Intravenous vancomycin must not be used to treat CDI - it does not penetrate into the lumen of the bowel

Overview of treatment

For an overview of the treatment of Clostridium difficile infection (CDI) see below.

Duration of treatment

10 days

First line - all severities

Therapy Notes

Vancomycin oral 125mg 6 hourly

IV Vancomycin cannot be used for treatment of CDI, as it does not penetrate into the lumen of the bowel.

Second line

Therapy Notes

Vancomycin oral up to 500mg 6 hourly

OR

Fidaxomicin* oral 200mg 12 hourly

*Fidaxomicin is a protected antimicrobial

IV Vancomycin cannot be used for treatment of CDI, as it does not penetrate into the lumen of the bowel.

Patients who fail to improve after 7 days oral vancomycin or continue to deteriorate should be discussed with an infection specialist.

Life-threatening CDI

Therapy Notes

Vancomycin oral 500mg 6 hourly

AND

Metronidazole IV 500mg 8 hourly 

IV Vancomycin cannot be used for treatment of CDI, as it does not penetrate into the lumen of the bowel.

Life-threatening CDI = any of the below attributable to CDI:

  • admission to ICU
  • new onset hypotension with or without need for vasopressors
  • ileus or significant abdominal distension
  • new or worsening confusion
  • WBC >35 x 109/L or lactate >2.2 mmol/L
  • evidence of end organ failure

Patients with suspected life-threatening CDI should be referred for senior surgical review as a matter of urgency.

Recurrence within 12 weeks of diagnosis

Therapy Notes

Fidaxomicin oral 200mg 12 hourly

If initial treatment course incomplete, treat as 1st episode.

Recurrence after >12 weeks from diagnosis

Use first line treatment option (see above).

Second recurrence

Discuss with infection specialist and consider Faecal Microbiota Transplant (FMT). Pulsed or tapered vancomycin if FMT not available

 

(Prescribing in acute care: A prescribing protocol for the antimicrobial agents recommended for treatment of C.Difficile infection is available on the Hospital Electronic Prescription, Monitoring and Administration (HEPMA) system. Search Protocols -> Clostridium difficile).

 

 

Page last updated: December 2025



;