Treatment of Clostridium difficile Infection After Two or More Recurrences
Patients who experience a second or subsequent recurrence of Clostridioides difficile infection — defined as having had at least two prior recurrences — form a distinct clinical group. With each additional episode, the risk of yet another recurrence rises, making this population a recognised priority for a targeted, protocol-driven treatment strategy.
Clinical scenario: Second or subsequent CDI recurrence (≥2 prior recurrences). This group is distinguished from patients experiencing only a first recurrence, reflecting the understanding that risk of a further recurrence increases with each episode of CDI.
Treatment approach
For patients with multiple CDI recurrences, the range of evidence-based options is broader than for a first recurrence. It includes more than one antibiotic-based strategy as well as, under appropriate circumstances, a microbiome-based intervention. Which option applies — and in what sequence — depends on the individual clinical picture.
Full regimen, criteria, and sequencing available in the complete protocol →
References
DOI: 10.1093/cid/ciab549
- With the understanding that risk of a subsequent recurrence increases with each episode of CDI, we continue to make a distinction between patients with a first CDI recurrence and those with multiple recurrences (≥2 recurrences).
- For patients with multiple recurrences, vancomycin in a tapered and pulsed regimen, vancomycin followed by rifaximin, and fecal microbiota transplantation are options in addition to fidaxomicin.
- Fidaxomicin 200 mg given twice daily for 10 days, OR twice daily for 5 days followed by once every other day for 20 days
- Vancomycin by mouth in a tapered and pulsed regimen
- Vancomycin 125 mg 4 times daily by mouth for 10 days followed by rifaximin 400 mg 3 times daily for 20 days
- Fecal microbiota transplantation
- The opinion of the panel is that appropriate antibiotic treatments for at least 2 recurrences (ie, 3 CDI episodes) should be tried prior to offering fecal microbiota transplantation
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