C.diff and antimicrobials in GP (2021 update)

This is a new guideline from Nice on antibiotic prescribing in C.difficile infection. It was published in July, and gives us an outline of what antibiotics to prescribe and also how else we should be managing patients. There is an excellent visual summary which really covers everything you need to know.

What was new to me in Nice’s guideline on antibiotic prescribing in C.difficile infection?

• Review the patient’s medications.
• Stop any non-essential antibiotics and consider changing to one with a lower risk of C. difficile if possible.
• Also consider stopping:
  • PPI.
  • Other medications with GI effects, like laxatives.
  • Medications that could cause problems if the patient becomes dehydrated eg NSAIDs, ACEi etc.
• Do not offer loperamide.
• Always seek specialist advice before prescribing for under 18s, and consider for adults too.
• Advise patients to drink enough to avoid dehydration.
• Counsel patients on infection prevention measures.
• Most patients will take seven to 14 days to improve, so reassess at seven days to see if the antibiotics are working.
• Antibiotic courses should be 10 days long.
• See the guideline for prescribing details (I am not listing them all here as they may change and we should be considering discussing them with a microbiologist). For most patients, vancomycin will the first line treatment.
• If patients have had two or more episodes of C. difficile, consider a faecal microbiota transplant.
• Remember that all cases of C. difficile must be reported.

The UK HSA has a lot more guidance on their website.