Treatment of Clostridioides difficile Colitis in Outpatient Settings

Disease Severity Assessment

The European Society of Clinical Microbiology and Infectious Diseases recommends that non-severe CDI be defined by stool frequency < 4 times daily 1
The Infectious Diseases Society of America suggests that non-severe CDI is characterized by no signs of severe colitis 1
The American College of Gastroenterology defines severe CDI by marked leukocytosis (WBC > 15 × 10^9/L) 2
The Society for Healthcare Epidemiology of America recommends that serum albumin < 30 g/L be used as a criterion for severe CDI 2
The International Society for Antimicrobial Chemotherapy suggests that a rise in serum creatinine (≥ 1.5 times baseline) indicates severe CDI 2
The World Health Organization defines severe CDI by temperature > 38.5°C 3
The Centers for Disease Control and Prevention suggests that hemodynamic instability is a criterion for severe CDI 3

The American College of Gastroenterology recommends metronidazole 500 mg orally three times daily for 10 days as a first-line treatment for non-severe CDI 1, 4
The Infectious Diseases Society of America suggests that vancomycin 125 mg orally four times daily for 10 days is an alternative first-line treatment for non-severe CDI 1
The European Society of Clinical Microbiology and Infectious Diseases recommends fidaxomicin 200 mg orally twice daily for 10 days as an alternative first-line treatment for non-severe CDI 4, 5

The American College of Gastroenterology recommends treating first recurrence based on severity as with initial episode 1, 2
The Infectious Diseases Society of America suggests that vancomycin or fidaxomicin be preferred over metronidazole for first recurrence 2
The Society for Healthcare Epidemiology of America recommends vancomycin 125 mg four times daily for at least 10 days for second or subsequent recurrences 1, 2

The Centers for Disease Control and Prevention recommends discontinuing the inciting antibiotic if clinically possible 5
The World Health Organization suggests avoiding antiperistaltic agents and opiates 1, 2
The European Society of Clinical Microbiology and Infectious Diseases recommends hand hygiene with soap and water (not alcohol-based sanitizers) 5

The American College of Gastroenterology recommends fecal microbiota transplantation (FMT) for multiple recurrences 5
The Infectious Diseases Society of America suggests that bezlotoxumab (monoclonal antibody against C. difficile toxin B) may prevent recurrences in high-risk patients 5

The European Society of Clinical Microbiology and Infectious Diseases recommends monitoring for clinical response (decreased stool frequency, improved consistency) within 3 days of treatment 3
The American College of Gastroenterology suggests that no follow-up stool testing is needed if symptoms resolve 2
The Infectious Diseases Society of America recommends watching for signs of treatment failure (absence of improvement after 3-5 days) 1