Synopsis
Diagnose symptomatic toxin-mediated C difficile infection, grade severity, stop avoidable drivers, deliver exact NICE-directed therapy and escalate early for fulminant colitis or recurrence.
- Test only symptomatic patients with new unformed stool and interpret organism and toxin results through the local two-stage or multistage laboratory algorithm.
- Do not perform a test of cure: C difficile can remain detectable after symptoms resolve.
- Isolate promptly, use gloves and aprons, wash hands with soap and water and clean the environment with a sporicidal agent.
Key red flags
Hypotension, rising lactate, altered mental state or organ dysfunction marks life-threatening colitis even if stool frequency falls.
High fever, marked leukocytosis, kidney injury, hypoalbuminaemia or severe abdominal tenderness indicates higher failure and complication risk.
Investigation priorities
Identify toxigenic organism and evidence of free toxin in a symptomatic unformed specimen.
Management branches
An adult develops otherwise unexplained unformed diarrhoea with antibiotic, healthcare or community risk.
- Place the patient in enteric isolation, use gloves and aprons and start soap-and-water and sporicidal environmental measures.
- Send one unformed stool sample through the local C difficile algorithm and assess alternative drug, feed and infectious causes.
Key medicines
Vancomycin for first episodeGive 125 mg orally four times daily for 10 days for an initial C difficile infection, including severe disease without life-threatening features.
FidaxomicinGive 200 mg orally twice daily for 10 days for a first recurrence within 12 weeks, or as NICE-directed second-line or later-recurrence therapy.