{ "schema_version": 1, "kind": "condition", "id": "c-difficile-infection", "name": "Clostridioides difficile Colitis", "category": "infectious", "sources": "IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)", "review_status": "reviewed", "verified_against": "IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph) · Clostridioides difficile infection - disease-level clinical article (c-difficile-infection-clinical.txt) · Clostridioides difficile Colitis - disease-level clinical article (c-difficile-infection-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 333, "generic": "Vancomycin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 125.0, "adult_dose": "125 mg ORALLY 4 times daily", "adult_duration": "10 days", "dose_source": "IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update", "rationale": "First-line oral treatment available in Egyptian hospitals and pharmacies; fidaxomicin is expensive and poorly available", "cautions": [ "MUST BE GIVEN ORALLY: IV vancomycin is NOT excreted into the intestinal lumen and is completely ineffective for C. difficile.", "Discontinue offending prior antibiotic if possible.", "Monitor for recurrence (20% of cases)." ], "peds_mgkg_low": 10.0, "peds_mgkg_high": 10.0, "peds_max_mg": 125.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "10 mg/kg orally 4 times daily (max 125 mg per dose) for 10 days", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 100, "high_mg": 100, "capped": false }, { "weight_kg": 20, "low_mg": 125, "high_mg": 125, "capped": true }, { "weight_kg": 30, "low_mg": 125, "high_mg": 125, "capped": true }, { "weight_kg": 40, "low_mg": 125, "high_mg": 125, "capped": true } ], "brands": [ { "trade_name": "KEMPOVANCOM 500 MG VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > MODERN OFFICE FOR IMPORT", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOZIN 500 MG VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIMC > KOREA UNITED PHARMA", "price_egp": 38.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOMIX 500MG I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC", "price_egp": 79.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOLON 500MG I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 95.5, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOMYCINE VIATRIS 500 MG VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "VIANAX - GREECE > ONE PHARMA MEDICS", "price_egp": 142.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VETOVANCIN 1 GM I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC > VETOPHARM-EGYPT", "price_egp": 176.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOMYCINE VIATRIS 1 GM VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "VIANAX - GREECE > ONE PHARMA MEDICS", "price_egp": 204.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOMYCIN-LYOMARK 1000MG VIAL FOR ORAL OR INF. USE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LYOMARK-PHARMA > PHARMACON", "price_egp": 226.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "c-difficile-infection" }, { "id": 335, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Clostridioides difficile infection - disease-level clinical article (c-difficile-infection-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - The laboratory criteria defining severe infection are WBC, albumin, and creatinine.", "RED FLAG - Ileus means oral vancomycin does not reach the colon adequately and IV metronidazole may be needed instead.", "RED FLAG - Fulminant colitis may require surgical intervention (subtotal colectomy).", "RED FLAG - An initial fulminant/severe episode (hypotension, shock, ileus, megacolon) needs much higher-dose vancomycin (500 mg) than the standard 125 mg dose.", "RED FLAG - Adjunctive IV metronidazole is recommended alongside vancomycin for an initial fulminant/severe episode." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "c-difficile-infection" }, { "id": 334, "generic": "Metronidazole", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "500 mg orally 3 times daily", "adult_duration": "10-14 days", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)", "rationale": "Second-line option for initial non-severe C. difficile episode when oral vancomycin is unavailable", "cautions": [ "Less effective than oral vancomycin; avoid in recurrent or severe colitis.", "Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023." ], "peds_mgkg_low": 7.5, "peds_mgkg_high": 7.5, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "7.5 mg/kg orally 3 times daily for 10 days", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 75, "high_mg": 75, "capped": false }, { "weight_kg": 20, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 30, "low_mg": 225, "high_mg": 225, "capped": false }, { "weight_kg": 40, "low_mg": 300, "high_mg": 300, "capped": false } ], "brands": [ { "trade_name": "DUMOZOL 500MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > ALPHARMA-DENMARK", "price_egp": 7.0, "pack_count": 20, "unit_price": 0.35, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOLGUARD 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA CO. > UNIPHARMA", "price_egp": 9.0, "pack_count": 20, "unit_price": 0.45, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NITROFECTAZOLE 500 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GYPTO PHARMA", "price_egp": 10.5, "pack_count": 20, "unit_price": 0.53, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLAGICURE FORTE 500 MG 20 F.C. TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 23.0, "pack_count": 20, "unit_price": 1.15, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRICHOGYL 500MG 12 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 15.0, "pack_count": 12, "unit_price": 1.25, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLAGELLAT FORTE 500MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 30.0, "pack_count": 20, "unit_price": 1.5, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GEDAZOLE 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JEDCO INT. CO. FOR PHARMACEUTICALS", "price_egp": 34.0, "pack_count": 20, "unit_price": 1.7, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METROGYPTON 500 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GYPTO PHARMA", "price_egp": 34.0, "pack_count": 20, "unit_price": 1.7, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUMOZOL 125MG/5ML SUSP. 125ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > ALPHARMA-DENMARK", "price_egp": 5.75, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "METROZOLE 125MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 19.5, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "c-difficile-infection" }, { "id": 336, "generic": "Rifaximin", "line": 3, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "400 mg orally 3 times daily", "adult_duration": "20 days", "dose_source": "Clostridioides difficile Colitis - disease-level clinical article (c-difficile-infection-clinical.txt)", "rationale": "Follow-on oral antibiotic regimen for second or subsequent recurrence of Clostridioides difficile infection.", "cautions": [ "Added to the lactulose, not instead of it. The licensed indication is preventing recurrence on top of lactulose, and stopping the lactulose loses most of the benefit.", "This is prevention after an episode has happened, not treatment of the acute confusion in front of you - that is still lactulose titrated to 2-3 soft stools a day.", "The 550 mg strength is the encephalopathy strength. The 200 mg tablets are the travellers' diarrhoea product and three of them a day is not the same prescription.", "Barely absorbed, so systemic side effects are few, but peripheral oedema and dizziness are reported in over 10%." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose is stated in the sources held for this drug.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "IDIBACT 200 MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA", "price_egp": 34.0, "pack_count": 10, "unit_price": 3.4, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRENCEDIA 200 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 130.5, "pack_count": 30, "unit_price": 4.35, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IDIBACT 550 MG 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA", "price_egp": 103.75, "pack_count": 20, "unit_price": 5.19, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FATROXIM 200 MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > ATM PHARMACEUTICAL INDUSTRIES", "price_egp": 81.0, "pack_count": 10, "unit_price": 8.1, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUFAXIMIN 200 MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 232.0, "pack_count": 28, "unit_price": 8.29, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BIOREFAMIN 550 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "P & C LABS > SOVALUE PHARMA", "price_egp": 148.0, "pack_count": 10, "unit_price": 14.8, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GASTROBIOTIC 550 MG 30 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 516.0, "pack_count": 30, "unit_price": 17.2, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRAVIGUARD 550 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "P AND C LABS > TREND PHARM", "price_egp": 344.0, "pack_count": 20, "unit_price": 17.2, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "c-difficile-infection" } ] }