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Clostridium difficile Colitis Therapeutic Response Criteria

Purpose: To evaluate a patient's response to therapy for Clostridium difficile colitis as reported by Gerding et al.

Description

Gerding et al discussed criteria for therapeutic response in a patient receiving antibiotics for Clostridium difficile colitis. This can help the clinician decide if more aggressive management is needed. The authors are from Hines Veterans Affairs Hospital, Loyal University Chicago, University of Pittsburgh, Maine Medical Center and the University of Vermont.


Clinical monitors:

(1) temperature

(2) white blood cell (WBC) count

(3) findings on an abdominal exam

(4) number of bowel movements

(5) general clinical status

 

In a patient who is being successfully treated, all of these parameters should be improving within 1-2 days of starting therapy. Diarrhea ideally should resolve in 3-6 days.

 

Failure to improve as expected or worsening of any parameter is an indication for more aggressive management, such as adding oral vancomycin to an oral metronidazole regimen.

 

The presence of toxin or Clostridium difficile on culture are not suitable endpoints for therapy since these can be shed for days or weeks following clinical recovery.


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Specialty

Objective

ICD-10