Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

C · C Diff

—

In one line

·C. difficile (a harmful germ) took over your gut after antibiotics wiped out the good bacteria that normally keep it under control.

—

Normal physiology

·Your colon (the last part of your intestine, also called the large bowel) is home to trillions of helpful bacteria that live in a careful balance. These good bacteria do important jobs: they help digest food, make vitamins, and crowd out harmful germs so they can't grow. Picture it like a healthy garden where good plants fill every inch of soil, leaving no room for weeds.

—

What goes wrong

·Antibiotics — especially fluoroquinolones (like ciprofloxacin or levofloxacin), clindamycin, and cephalosporins (like ceftriaxone) — kill the good bacteria in your gut. With the good bacteria gone, C. difficile spores wake up, multiply fast, and release two powerful toxins (A and B) that punch holes in the cells lining your colon, causing inflammation, watery diarrhea, and sometimes life-threatening damage.

—

Hallmark signs

—

Red flags · escalate now

·White blood cell count above 15,000 per microliter or blood lactate above 2.2 mmol/L (signs the infection is severe and the body is struggling)
·Swollen colon larger than 6 centimeters on imaging (risk the colon could tear open, called toxic megacolon)
·Low blood pressure, confusion, or organ failure (signs of life-threatening septic shock)

—

Workup

·Stool test for C. difficile toxin gene by PCR (polymerase chain reaction)
·Two-step stool test: GDH (glutamate dehydrogenase) enzyme test, then toxin EIA (enzyme immunoassay) if GDH is positive
·Complete blood count (CBC) with white blood cell count and differential
·Serum creatinine and blood urea nitrogen (BUN)
·Serum lactate
·CT scan of the abdomen and pelvis with IV contrast
·Serum albumin

—

Treatment

·Stop the antibiotic that triggered the infection (if medically safe to do so)
·Give oral vancomycin 125 mg four times daily for 10 days for non-severe infection
·Give oral fidaxomicin 200 mg twice daily for 10 days (alternative first-line, especially if high risk for recurrence)
·For severe infection (white blood cell count ≥15,000 or creatinine ≥1.5 times baseline), give oral vancomycin 125 mg four times daily; if very severe (shock, a stalled gut (ileus), megacolon, or ICU care needed), increase to 500 mg four times daily
·For fulminant (life-threatening) infection—especially with a stalled gut (ileus), toxic megacolon, or shock—add IV metronidazole 500 mg every 8 hours AND consider vancomycin enemas (500 mg in 100–500 mL saline every 6 hours if a stalled gut present)
·For first recurrence, use oral fidaxomicin 200 mg twice daily for 10 days, OR use a tapered and pulsed vancomycin regimen (125 mg four times daily for 10–14 days, then twice daily for a week, then once daily for a week, then once every 2–3 days for 2–8 weeks)
·For second or later recurrence, consider fecal microbiota transplant (FMT, putting stool from a healthy donor into the patient's colon), OR give bezlotoxumab IV (a single 10 mg/kg infusion during antibiotic treatment)
·Use contact precautions in the hospital: gloves and gown for all contact, and wash hands with soap and water (not alcohol gel, because alcohol does not kill C. difficile spores)

—

NCLEX trap

·Stop the antibiotic that caused C. diff if you can. More antibiotics kill the last good bacteria left and let C. diff grow wild. Only vancomycin by mouth or fidaxomicin by mouth work against C. diff because they stay in the gut and kill C. diff without hurting the rest of the body.
·Antidiarrheal drugs trap the poison (toxin) inside the colon and can cause the colon to balloon up and tear open (toxic megacolon). In C. diff, diarrhea is the body's way of flushing out the poison—let it happen.
·In a hospitalized patient or anyone who took antibiotics in the past 3 months, diarrhea is C. diff until proven otherwise. Test for C. diff toxin right away and start treatment early—waiting lets the colon get damaged.
·Treat C. diff as soon as you see watery diarrhea after antibiotics and get a positive C. diff test. Do not wait for organ damage. Early treatment with vancomycin by mouth or fidaxomicin by mouth stops C. diff before it gets dangerous.
·If C. diff recurs, use fidaxomicin (better at stopping recurrence), or taper vancomycin slowly over weeks, or give bezlotoxumab (an antibody that blocks the toxin), or do a fecal microbiota transplant (poop transplant). Recurrence means the gut bacteria are still not balanced.
·Alcohol does not kill C. diff spores (the tough seeds that survive outside the body). Use soap and water to wash hands and bleach to clean surfaces. C. diff spreads through spores that alcohol cannot destroy—only soap and water plus bleach work.

—

Install Maldek by Hill as an app — studies work even offline