C difficile Infection guideline – comparison between NICE 2021 and IDSA 2021
drsuryabrata@gmail.comWhat does NICE guideline 2021 say about assessing and managing C difficile infection?
Comparison between NICE 2021 guideline and IDSA 2021 update
| IDSA/SHEA focussed update 2021 | NICE 2021 | |
| 1st episode of CDAD -1st line | Fidaxomicin 200 mg BO PO 10 days | Vancomycin 125 mg QDS PO 10 days |
| 1st episode of CDAD - 2nd line | Vancomycin 125 mg QDS PO 10 days | Fidaxomicin 200 mg BO PO 10 days |
| 1st episode of CDAD - Non-severe CDAD or above agents not available | Metronidazole 500 mg TDS PO 14 days | |
| 1st episode of CDAD -1st and 2nd line ineffective | Vancomycin Upto 500 mg QDS PO 10 days +/- Metronidazole 500 mg IV TDS 10 days [2] | |
| 1. Fidaxomicin 200 mg BO PO 10 days [1] OR, 2. Fidaxomicin BO PO 5 days followed by once every other day for 20 days [1] OR, 3. Vancomycin by mouth in a tapered and pulsed regimen [1] OR, 4.Vancomycin 125 mg 4 times daily by mouth for 10 days followed by rifaximin 400 mg 3 times daily for 20 days [1] OR, 5. Fecal microbiota transplantation [5] | Fidaxomicin 200 mg BO PO 10 days | |
| Further episodes after 12 weeks (recurrence) | 1. Vancomycin 125 mg QDS PO 10 days OR, 2. Fidaxomicin 200 mg BO PO 10 days | |
| 1st C diff recurrence 1st line | 1. Fidaxomicin 200 mg BO PO 10 days [1] OR, 2. Fidaxomicin BO PO 5 days followed by once every other day for 20 days [1] | |
| 1st C diff recurrence 2nd line | 1. Vancomycin by mouth in a tapered and pulsed regimen [1,4] OR, 2. Vancomycin 125 mg QDS PO 10 days [1] | |
| 2nd or subsequent recurrence | Appropriate antibiotic treatments for at least 2 recurrences (ie, 3 CDI episodes) should be tried prior to offering faecal microbiota transplantation. | |
| Vancomycin 500 mg 4 times daily by mouth or by nasogastric tube. If ileus, consider adding rectal instillation of vancomycin. Intravenously administered metronidazole (500 mg every 8 hours) should be administered together with oral or rectal vancomycin, particularly if ileus is present. | Life-threatening C difficile infection/ Fulminant C difficile infection | Vancomycin Upto 500 mg QDS PO 10 days+/- Metronidazole 500 mgIV TOS 10 days [3] |
| Faecal microbiota transplantation | Appropriate antibiotic treatments for at least 2 recurrences (i.e., 3 CDI episodes) should be tried before offering faecal microbiota transplantation. | Recurrent episode of infection after 2 or more previous episodes |
| [1] | Adjunctive treatment (with fidaxomicin or vancomycin): Bezlotoxumab 10 mg/kg given intravenously once during the administration of soc antibiotics. Data, when combined with fidaxomicin, are limited. caution for use in patients with congestive heart failure | |
| [2] | Adjunctive treatment (with fidaxomicin or vancomycin): Bezlotoxumab 10 mg/kg given intravenously once during the administration of soc antibiotics. Data, when combined with fidaxomicin, are limited. Caution for use in patients with congestive heart failure | |
| [3] | Seek specialist opinion, may need surgery | |
| [4] | Tapered/pulsed vancomycin regimen: 125 mg 4 times daily for 1 14 days, 2 times daily for 7 days, once daily for 7 days, and then every 2 to 3 days for 2 to 8 weeks | |
| [5] | Appropriate antibiotic treatments for at least 2 recurrences (ie, 3 CDI episodes) should be tried prior to offering faecal microbiota transplantation |
