🦠 Clostridioides difficile Infection (CDI) Treatment
This tool gives the Clostridioides difficile infection regimen by episode and severity, covering initial, recurrent, and fulminant disease.
Clostridioides difficile Infection (CDI) Treatment
Episode
Severity
When to use
Use to choose fidaxomicin or vancomycin for initial/recurrent CDI, taper-pulse or FMT for multiple recurrences, and high-dose vancomycin + IV metronidazole for fulminant disease.
How it works
Initial (non-severe/severe) → fidaxomicin or oral vancomycin × 10 days. First recurrence → fidaxomicin or vancomycin taper-pulse. Multiple recurrences → taper-pulse/rifaximin/FMT. Fulminant → high-dose vancomycin + IV metronidazole + surgery.
Key points
- Metronidazole is no longer a first-line agent and is reserved for non-severe disease only when a preferred drug is unavailable. (original synthesis · not guideline verbatim)
- A test of cure is not performed, since asymptomatic carriage can persist.
- Bezlotoxumab may be added to reduce recurrence in high-risk patients.
References
- Johnson S, et al. IDSA/SHEA 2021 Focused Update Guidelines on Management of CDI in Adults. Clin Infect Dis 2021.
- Kelly CR, et al. ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of CDI. Am J Gastroenterol 2021.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.