C. difficile treatment
Antibiotic, dosage and course
Treatment length
First-line antibiotic for a first episode Vancomycin:
of mild, moderate or severe C. difficile
125 mg orally four times a day
infection
for 10 days
Second-line antibiotic for a first Fidaxomicin:
episode of mild, moderate or severe C.
200 mg orally twice a day for
difficile infection if vancomycin is
10 days
ineffective
Antibiotics for C. difficile infection if Seek specialist advice.
first- and second-line antibiotics are Specialists may initially offer:
ineffective
Vancomycin:
Up to 500 mg orally four times
a day for 10 days
With or without
Metronidazole:
500 mg intravenously three
times a day for 10 days
,Antibiotic for a further episode of C. Fidaxomicin:
difficile infection within 12 weeks of
200 mg orally twice a day for
symptom resolution (relapse)
10 days
Antibiotics for a further episode of C. Vancomycin:
difficile infection more than 12 weeks
125 mg orally four times a day
after symptom resolution (recurrence)
for 10 days
Or
Fidaxomicin:
200 mg orally twice a day for
10 days
Antibiotics for life-threatening C. Seek urgent specialist advice,
difficile infection (also see which may include surgery.
recommendation 1.1.16) Antibiotics that specialists
may initially offer are:
Vancomycin:
500 mg orally four times a day
for 10 days
With
Metronidazole:
, 500 mg intravenously three
times a day for 10 days
There are however some key differences which are highlighted in table below:
Crohn's disease (CD) Ulcerative colitis (UC)
Features Diarrhoea usually Bloody diarrhoea more common
non-bloody Abdominal pain in the left lower
Weight loss more prominent quadrant
Upper gastrointestinal Tenesmus
symptoms, mouth ulcers,
perianal disease
Abdominal mass palpable
in the right iliac fossa
Extra-intestin Gallstones are more Primary sclerosing cholangitis more
al common secondary to common
reduced bile acid
reabsorption
Oxalate renal stones*
Complication Obstruction, fistula, Risk of colorectal cancer high in UC
s colorectal cancer than CD
Pathology Lesions may be seen Inflammation always starts at
anywhere from the mouth to rectum and never spreads beyond
anus ileocaecal valve
Skip lesions may be present Continuous disease
, Histology Inflammation in all layers No inflammation beyond submucosa
from mucosa to serosa (unless fulminant disease) -
● increased goblet inflammatory cell infiltrate in lamina
cells propria
● granulomas ● neutrophils migrate through
the walls of glands to form
crypt abscesses
● depletion of goblet cells and
mucin from gland epithelium
● granulomas are infrequent
Endoscopy Deep ulcers, skip lesions - Widespread ulceration with
'cobble-stone' appearance preservation of adjacent mucosa
which has the appearance of polyps
('pseudopolyps')
Radiology Small bowel enema Barium enema
● high sensitivity and ● loss of haustrations
specificity for ● superficial ulceration,
examination of the 'pseudopolyps'
terminal ileum ● long standing disease: colon
● strictures: 'Kantor's is narrow and short -'drainpipe
string sign' colon'
● proximal bowel
dilation
● 'rose thorn' ulcers
● fistulae
*impaired bile acid rebsorption increases the loss calcium in the bile. Calcium
normally binds oxalate.
Primary biliary cholangitis
Primary biliary cholangitis (previously referred to as primary biliary cirrhosis) is a
chronic liver disorder typically seen in middle-aged females (female:male ratio of
9:1). The aetiology is not fully understood although it is thought to be an
autoimmune condition. Interlobular bile ducts become damaged by a chronic
Antibiotic, dosage and course
Treatment length
First-line antibiotic for a first episode Vancomycin:
of mild, moderate or severe C. difficile
125 mg orally four times a day
infection
for 10 days
Second-line antibiotic for a first Fidaxomicin:
episode of mild, moderate or severe C.
200 mg orally twice a day for
difficile infection if vancomycin is
10 days
ineffective
Antibiotics for C. difficile infection if Seek specialist advice.
first- and second-line antibiotics are Specialists may initially offer:
ineffective
Vancomycin:
Up to 500 mg orally four times
a day for 10 days
With or without
Metronidazole:
500 mg intravenously three
times a day for 10 days
,Antibiotic for a further episode of C. Fidaxomicin:
difficile infection within 12 weeks of
200 mg orally twice a day for
symptom resolution (relapse)
10 days
Antibiotics for a further episode of C. Vancomycin:
difficile infection more than 12 weeks
125 mg orally four times a day
after symptom resolution (recurrence)
for 10 days
Or
Fidaxomicin:
200 mg orally twice a day for
10 days
Antibiotics for life-threatening C. Seek urgent specialist advice,
difficile infection (also see which may include surgery.
recommendation 1.1.16) Antibiotics that specialists
may initially offer are:
Vancomycin:
500 mg orally four times a day
for 10 days
With
Metronidazole:
, 500 mg intravenously three
times a day for 10 days
There are however some key differences which are highlighted in table below:
Crohn's disease (CD) Ulcerative colitis (UC)
Features Diarrhoea usually Bloody diarrhoea more common
non-bloody Abdominal pain in the left lower
Weight loss more prominent quadrant
Upper gastrointestinal Tenesmus
symptoms, mouth ulcers,
perianal disease
Abdominal mass palpable
in the right iliac fossa
Extra-intestin Gallstones are more Primary sclerosing cholangitis more
al common secondary to common
reduced bile acid
reabsorption
Oxalate renal stones*
Complication Obstruction, fistula, Risk of colorectal cancer high in UC
s colorectal cancer than CD
Pathology Lesions may be seen Inflammation always starts at
anywhere from the mouth to rectum and never spreads beyond
anus ileocaecal valve
Skip lesions may be present Continuous disease
, Histology Inflammation in all layers No inflammation beyond submucosa
from mucosa to serosa (unless fulminant disease) -
● increased goblet inflammatory cell infiltrate in lamina
cells propria
● granulomas ● neutrophils migrate through
the walls of glands to form
crypt abscesses
● depletion of goblet cells and
mucin from gland epithelium
● granulomas are infrequent
Endoscopy Deep ulcers, skip lesions - Widespread ulceration with
'cobble-stone' appearance preservation of adjacent mucosa
which has the appearance of polyps
('pseudopolyps')
Radiology Small bowel enema Barium enema
● high sensitivity and ● loss of haustrations
specificity for ● superficial ulceration,
examination of the 'pseudopolyps'
terminal ileum ● long standing disease: colon
● strictures: 'Kantor's is narrow and short -'drainpipe
string sign' colon'
● proximal bowel
dilation
● 'rose thorn' ulcers
● fistulae
*impaired bile acid rebsorption increases the loss calcium in the bile. Calcium
normally binds oxalate.
Primary biliary cholangitis
Primary biliary cholangitis (previously referred to as primary biliary cirrhosis) is a
chronic liver disorder typically seen in middle-aged females (female:male ratio of
9:1). The aetiology is not fully understood although it is thought to be an
autoimmune condition. Interlobular bile ducts become damaged by a chronic
