Checklist of markers of C. difficile severe disease* (1 or more of)

Clinical

• Temperature > 38.5 C
   
• Haemodynamic instability
   
• Peritonitis (abdominal tenderness)
   
• Ileus

Laboratory

• Albumin < 25 g/L
   
• Increased lactate
   
• White cell count > 15 x 10^9/L
   
• Creatinine increased > 50% above baseline

Other (e.g., on Xray, CT, colonoscopy)

• Bowel perforation
   
• Colonic distension
   
• Toxic megacolon
   
• Pseudomembranes visible

*Severe disease should be treated from outset with vancomycin 125 mg qid AND you should consider an infectious diseases consult.

Other indications for vancomycin = unresponsive to treatment with metronidazole with >= 3 stools/24 hours after 3 days OR 2nd and subsequent relapses.

Source: Upcoming ASID guidelines on C. difficile (to be published in the MJA)