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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98277-en.cckm

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP – Clostridium Difficile Treatment – Adult – Supplemental [5316]

IP – Clostridium Difficile Treatment – Adult – Supplemental [5316] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Clostridium Difficile Treatment - Adult - Supplemental [5316]
URL:
Isolation Status
for Clostridium both orders if patient is not currently under Enhanced Contact precautions Select
Difficile
Isolation [146428]
Enhanced Contact Isolation - CDIFF [ISO0348] What is the reason for isolation? CDIFF
Isolation Cart [EQP0016] CONTINUOUS, Routine
Patient Care Orders
Non-Categorized Patient Care Orders [146438]
Provide Patient Education [NURCOM0025] ONCE, Routine, Provide patient with the following
patient education: What You Need to Know About
Clostridium Difficile Infection (CDI) - Health Facts For
You [7219]
Treatment Medications
Therapy without diagnostics suspicion is usually not appropriate. Treatment decision should be
based upon the severity of Clostridium difficile infection as determined by thoughtful clinical
decision support.
UW Health Adult Guidelines for Diagnosis,
Treatment, and Prevention of Clostridium Difficile
Infection
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/infection-and-isolation/name-
97536-en.cckm
Anti-infectives [145364]
Prevention, Diagnosis, and Treatment of Clostridium difficile Infection - Adult/Pediatric –
Inpatient/Ambulatory Clinical Practice Guideline
Definitions from UW Health Clostridium difficile Infection (CDI) Adult Treatment Algorithm
Asymptomatic Carriage: C. difficile PCR positive without diarrhea, ileus, or colitis
C. Diff Infection: C. difficile PCR positive with diarrhea but no manifestations of moderate to severe
disease (defined below)
Severe CDI: C. difficile infection and one or more of the following risk factors and/or manifestations:
Immunocompromised, on hemodialysis, age >60 years, albumin < 2.5 mg/dL, WBC Greater than or
equal to 15,000 cells/mm3, abdominal tenderness, elevated serum creatinine > 1.5x the premorbid
level
Severe, complicated CDI: ICU/IMC admission, ileus, toxic megacolon, diverting ileostomy or
significant abdominal distension, SIRS, hypotension with or without required use of vasopressors felt to
be related to CDI, WBC > 30,000 cells/mm3 or < 1,000 cells/mm3, serum lactate > 2.2. mmol/L, or end
organ failure felt to be related to CDI
Recurrent disease:
First episode of recurrent disease should be treated the vancomycin PO regardless of initial
therapy
Second episode of recurrent disease should be treated with vancomycin PO taper
Serious or multiple recurrences should consult ID and GI for consideration alternative therapy
and/or fecal microbiota transplant
Mild or moderate infection (metRONIDazole)
[224954]
metRONIDazole (FLAGYL) tab - 10-14 days
[39639]
500 mg, Oral, 3 X DAILY
Severe infection or first episode of recurrence
(vancomycin) [224955]
vancomycin (VANCOCIN) 50 MG/ML soln - 14
days [163204]
125 mg, Oral, 4 X DAILY For 14 Days
Page 1 of 2
Printed by WILLIAMS, HEATHER R [HRS0] at 11/28/2017 8:07:35 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Severe complicated infection (vancomycin and
metRONIDazole) [224956]
vancomycin (VANCOCIN) 50 MG/ML soln
[163204]
500 mg, Oral, 4 X DAILY For 14 Days
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, 3 X DAILY For 14 Days
If unable to tolerate oral therapy or complete ileus
and severe complicated infection (vancomycin
and merRONIDazole) [224958]
vancomycin in sodium chloride 0.9% 500 MG/100
ML rectal soln [785140]
500 mg, Rectal, 4 X DAILY For 14 Days
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, 3 X DAILY For 14 Days
Recurrent disease, second recurrence or more
(vancomycin taper) [239622]
"Followed by" Linked Panel
vancomycin (VANCOCIN) 50 MG/ML soln
[163204]
125 mg, Oral, EVERY 12 HOURS For 7 Days
vancomycin (VANCOCIN) 50 MG/ML soln
[163204]
125 mg, Oral, 1 X DAILY For 7 Days
vancomycin (VANCOCIN) 50 MG/ML soln - 2-8
Weeks [163204]
125 mg, Oral, EVERY 48 HOURS For 7 Days
vancomycin (VANCOCIN) 50 MG/ML soln
[163204]
125 mg, Oral, EVERY 72 HOURS For 7 Days
Recurrent disease, second recurrence or more
alternative therapy (fidaxomicin) [224965]
fidaxomicin (DIFICID) tab [146000] 200 mg, Oral, 2 X DAILY For 10 Days
C DIFF TOXIN B PCR, NAP1 IF POSITIVE
[130522]
C DIFF TOXIN B PCR, NAP1 IF POSITIVE
[HCCDIFPCR]
ONCE For 1 Occurrences, Routine, Reserve testing
for patients with 3 or more unformed stools in 1 or
more days. Do not repeat a negative test within 7
days. Do not perform for test of cure. Samples
positive for the C. difficile toxin B gene (tcdB) will
also be tested for the hypervirulent epidemic strain
(O27/NAP1/BI).
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Enhanced Contact Isolation - CDIFF or Acute
Gastroenteritis [ISO0348]
What is the reason for isolation? CDIFF
Medications - Severe Refractory With Failed Attempts on Vancomycin and
Metronidazole
UW Health Adult Guidelines for Diagnosis,
Treatment, and Prevention of Clostridium Difficile
Infection
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/infection-and-isolation/name-
97536-en.cckm
SEVERE REFRACTORY C.Difficile With failed attempts on vancomycin and metrondazole [145031]
page 3333 to speak 2300 -Disease authorization is required to order tigecycline. Between 0700Infectious
0700 a single dose may be ordered, but subsequent to Infectious Disease physician on call. From 2300 to
authorization.doses will require ID
Refractory C. Difficile [228381]
vancomycin (VANCOCIN) 50 MG/ML soln
[163204]
500 mg, Oral, EVERY 6 HOURS
May administer PO or NG
tigecycline (TYGACIL) bag [700285] 100 mg, Intravenous, ONCE For 1 Doses
tigecycline (TYGACIL) bag [700285] 50 mg, Intravenous, EVERY 12 HOURS Starting
12/10/17 For 365 Days
Page 2 of 2
Printed by WILLIAMS, HEATHER R [HRS0] at 11/28/2017 8:07:35 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org