The Infectious Diseases Society of America guidelines on the management of Clostridium difficile-associated disease have been recently updated. The most notable change in recommendations from prior guidelines is that oral metronidazole is no longer a first-line option in the management of mild-to-moderate disease.
Our local guidelines (available under the Guidelines/GLA Guidelines link above) have been updated accordingly. Both the standard 10-14d course of oral vancomycin for initial disease and oral vancomycin tapers for recurrent disease no longer require approval from the Infectious Diseases service. We have also created order sets for management of C. difficile in the "Outpatient Antibiotic Protocols" and "Inpatient Antibiotic Protocols" order sets that are available within most CPRS order sets. The ID service highly encourages use of the antibiotic protocol order sets, as they are routinely updated to be consistent with local and national guidelines for management of common infectious conditions.
GLA will also be soon be participating in a VA Cooperative Studies Program study in which patients with first recurrence of C. difficile disease will be randomized to receive a standard vs. tapering vancomycin course vs. fidaxomicin. More details to follow.