Antibiotic Treatment for Both C. difficile and UTI

Introduction to C. difficile Treatment

• The American College of Gastroenterology recommends oral vancomycin (125 mg four times daily for 10 days) as the preferred treatment for C. difficile infection, which works by concentrating in the gut lumen where C. difficile resides 1, 2, 3.
• The Infectious Diseases Society of America notes that intravenous vancomycin has no effect on CDI because it is not excreted into the colon 2, 4.
• The Society for Healthcare Epidemiology of America suggests fidaxomicin (200 mg twice daily for 10 days) as an alternative, particularly for patients at high risk for recurrence 1, 2, 3.

Introduction to UTI Treatment

• The European Urology Association states that parenteral aminoglycosides are classified as lower-risk antibiotics for CDI compared to fluoroquinolones, cephalosporins, or penicillins 5, 3.
• The International Clinical Practice Guidelines recommend avoiding fluoroquinolones, cephalosporins, and clindamycin entirely in patients with recent CDI history and developed UTI 5.

Treatment Algorithm

• The World Gastroenterology Organisation suggests continuing oral vancomycin 125 mg four times daily for the CDI, and adding intramuscular gentamicin once daily for 3 days for uncomplicated UTI 1, 2, 3.
• The American Urological Association recommends discontinuing any other antibiotics that may have precipitated the CDI, and stopping unnecessary proton pump inhibitors as they increase CDI risk 5, 3, 6, 3.