Surgical intervention for total colectomy should be considered early if patient is clinically unstable secondary to CDI.
Most patients with severe CDI should undergo abdominal CT to rule out toxic megacolon or pancolitis.
Early therapy appears to be important, especially in elderly patients. It may be necessary to discontinue the offending agent and initiate therapy while the toxin assay is pending.
Do not use antimotility agents (e.g., imodium)
Offending antimicrobial agents should be discontinued.
Prophylactic use of oral vancomycin 125 mg PO BID in patients receiving antimicrobial therapy for treatment of underlying infections (other than CDI) is recommended in patients with a history of C diff with multiple recurrences.
Data do not support the use of probiotics to treat CDI.
Use of probiotics for prevention may be considered on a case-by-case basis as supportive data are equivocal, but not recommended in immunocompromised or critically ill patients
Cholestyramine is of questionable efficacy and binds oral vancomycin. Its use is not advised.
Consider Infectious Diseases consultation for fecal microbial transplantation evaluation