CUH AB Guidelines Appendix 4 CDAD

Appendix 4: Management of Clostridium difficile associated diarrhoea

Risk factors for CDAD

Antibiotic Associated Diarrhoea (AAD) occurs in association with the administration of antibiotics. The spectrum of findings ranges from colitis to so-called 'nuisance' diarrhoea. Infection with Clostridium difficile accounts for only 10 to 20% of the cases of AAD, but it accounts for the majority of cases of colitis. Major risk factors for C. difficile infection include: advanced age, hospitalisation, exposure to antibiotics.

Some antibiotics are frequently implicated in C. difficile associated diarrhoea (CDAD) – e.g. Cephalosporins, Clindamycin, Quinolones and broad spectrum antibiotics, but virtually any antibiotic may be implicated, including brief courses e.g. surgical prophylaxis. Occasional cases follow chemotherapy treatments of cancer.

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The usual presentation is watery diarrhoea and cramps associated with antibiotic use.

Definition of CDAD

A patient to whom one or more of the following criteria applies:

Classification of CDAD

Grades CDAD

Mild disease

  • Diarrhoea
  • Lower Abdo Cramping pain

Severe C. diff

  • Ileus /Toxic megacolon
  • Low Albumin
  • High WCC
  • Fever
  • Abdominal distension,pain
  • Hypotension
  • Metabolic acidosis
  • Diarrhoea may be absent in severe disease
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management CDAD

Algorithm for management 1st or 2nd episode of CDAD

Management Algoreithm 1st 2nd episode CDAD

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Algorithm for management recurrent CDAD

Algorithm management recurrent CDAD