Infectious Diseases I

Clinical

Definition

ACG 2013

IDSA/SHEA 2018

2021 Focused Update

ACG 2021

Initial episode,

nonsevere

Metronidazole

500 mg PO/

for 10 days

Vancomycin 125 mg

PO/NG/FT 4 times

daily for 10 days

—OR—

Fidaxomicin 200 mg

BID for 10 days

Alternative:

Metronidazole 500

mg PO/NG/FT TID

for 10–14 days

(delayed response)

Fidaxomicin 200 mg

PO/NG/FT BID for

10 days

Alternative: Vancomycin

125 mg PO/NG/FT 4

times daily for 10 days

Alternative for nonsevere

infection if above

agents are unavailable:

Metronidazole 500 mg

PO/NG/FT TID for 10–14

days (delayed response)

Fidaxomicin 200

mg PO/NG/FT BID

for 10 days (strong

recommendation;

moderate-quality

evidence)

—OR—

Vancomycin 125

mg PO/NG/FT

4 times daily for

10 days (strong

recommendation; low-

quality evidence)

Initial episode,

severe

Vancomycin

125 mg PO/

NG/FT 4

times daily for

10 days

Vancomycin 125 mg

PO/NG/FT 4 times

daily for 10 days

—OR—

Fidaxomicin

200 mg BID for 10

days

Vancomycin 125 mg

PO/NG/FT 4 times

daily for 10 days (strong

recommendation; low-

quality evidence)

—OR—

Fidaxomicin 200 mg

PO/enteral BID for

10 days (conditional

recommendation; very

low-quality evidence)

Initial episode,

severe

complicated

(ACG)/

fulminant

(IDSA)

Vancomycin

125 mg PO/

NG/FT 4

times daily +

metronidazole

500 mg IV

TID

Ileus:

Vancomycin

500 mg PO/

NG/FT and per

rectum (NS

500 mL) +

metronidazole

500 mg IV

TID

Vancomycin 500

mg PO/NG/FT

4 times daily +

metronidazole 500

mg IV TID

Ileus: Add rectal

vancomycin 500 mg/

NS 100 mL instilled

for 1 hr 4 times daily

Vancomycin 500 mg PO/

NG/FT 4 times daily +

metronidazole 500 mg IV

TID

Ileus: Add rectal

vancomycin 500 mg/ NS

100 mL instilled for 1 hr

4 times daily

Same as IDSA/SHEA

Surgery: Suggest

total colectomy with

end ileostomy and

stapled rectal stump

or diverting loop

ileostomy with colonic

lavage and intraluminal

vancomycin