Guidelines:

1. Oral Vancomycin will replace oral Flagyl as first line therapy. This will require an ID consult.
2. When ordering C. difficile or when a patient is C. difficile positive, guidelines will pop up. (see attached)
3. ID is to see all patients who meet the following criteria:
• WBC Is greater than 15
• The pt has a decreasing serum bicarbonate level
• Rising creatinine
• Abdominal pain
• Abdominal tenderness and/or distention
• Evidence of thickening or dilation of bowel on an imaging study
4. All patients who are hospitalized must be started on oral Vancomycin and IV Flagyl for a positive C. difficile as well as presumed C. difficile.
5. For severe cases as described in item 3, the following will occur;

1- Patient will be placed on oral vanco, IV Flagyl and watched closely.

2- Surgery will see patient – KUB should be ordered at same time as CAT scan

3- IVIG will be as per discretion of the ID team

4- Intracolonic Vancomycin will be decided on with ID and surgery.

· A surgery attending should be involved with this decision. (Guidelines included)

5- Criteria/indications for surgical intervention will be made by the surgical team.

6- Isolates will be sent to DOH and state for testing

7- Lactates should be followed in these patients

8- Patients with any of these criteria should be moved to an ICU for monitoring and administration of intracolonic vancomycin