Recurrence - subsequent recurrence (3rd or greater episode)
- Recurrence after first episode occurs in up to 30% of patients, and as high as 65% after first recurrence.
- Consider referral for fecal microbiota transplant (FMT).
Prevention of recurrent CDI:
[Am J Gastroenterol 2021;116:1124-47]
- Consider oral vancomycin prophylaxis (125mg PO daily for duration of systemic antibiotic use plus 5 days) to prevent further recurrence during subsequent non-CDI systemic antibiotic use in patients who are at high risk of recurrence:
- patients hospitalized for severe CDI in past 3 months
AND either:
- 65 years or older, or
- immunocompromised.
- Prevention of CDI with metronidazole is NOT recommended due to potential for toxicity and lack of evidence of efficacy.
Usual Pathogens
Clostridioides difficile
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin taper-pulse | 125mg PO/NG qid | 14 days |
| 125mg PO/NG bid | 7 days | |
| 125mg PO/NG daily | 7 days | |
| 125mg PO/NG q2 days | 4 doses | |
| 125mg PO/NG q3 days | 4 doses |
Vancomycin allergy/intolerance
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Fidaxomicin | 200mg PO bid | 10 days |
| or | ||
| Fidaxomicin extended-pulse |
200mg PO bid, then 200mg PO every other day |
5 days 20 days |