Clostridioides difficile Severity Grading
Grades C. difficile infection (CDI) severity using ESCMID/IDSA criteria. Guides fidaxomicin vs vancomycin vs bezlotoxumab vs surgery decisions.
Score interpretation
No severe or fulminant feature.
→ Adults: fidaxomicin 200mg BD 10 days (preferred — lower recurrence) or oral vancomycin; metronidazole only if neither is available (ESCMID 2021); stop precipitating antibiotics; contact precautions; daily stool count; test of cure not recommended. Children: use a children's formulary.
WBC > 15 ×10⁹/L, creatinine > 1.5 mg/dL (or > 50% above baseline) or fever > 38.5 °C.
→ Adults: oral vancomycin 125mg QDS 10 days; fidaxomicin preferred for recurrence risk; bezlotoxumab 10mg/kg IV single dose if >=2 risk factors for recurrence (discontinued in the US in January 2025 — check local availability); surgical review. Children: use a children's formulary.
Hypotension or shock, ileus, toxic megacolon, perforation or raised lactate.
→ Adults: oral vancomycin (500mg QDS; add rectal vancomycin if ileus) + IV metronidazole 500mg TDS (IV vancomycin does not reach the colon); ICU; surgical team: subtotal colectomy criteria (toxic megacolon, perforation, multi-organ failure); faecal microbiota transplant for recurrent CDI; ID team lead. Children: use a children's formulary.
Interpretation bands for the C. diff Severity. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Activated Charcoal · Gastrointestinal decontamination / Antidote
- Terlipressin · Gastrointestinal Emergency
- Octreotide · Gastrointestinal Emergency
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.