Approach to management of recurrent Clostridium difficile diarrhoea
| First recurrence |
| • Confirm diagnosis |
| • Symptomatic treatment if symptoms are mild |
| • 10–14 day course of metronidazole or vancomycin |
| Second recurrence |
| • Confirm diagnosis |
| • Vancomycin1-150 taper |
| 125 mg q 6 h for 7 days |
| 125 mg q 12 h for 7 days |
| 125 mg qd for 7 days |
| 125 mg qod for 7 days |
| 125 mg every 3 days for 7 days |
| Further recurrences |
| • Vancomycin in tapering dose as above plus cholestyramine 4 g bid or |
| • Vancomycin 125 mg qid and rifampicin 600 mg bid for 7 days or |
| • Therapy with microorganisms (eg, Saccharomyces boulardiiin combination with metronidazole or vancomycin) or |
| • Intravenous immunoglobulin |
↵1-150 Metronidazole may be substituted for vancomycin although there are no published data regarding its efficacy in this treatment regimen
q 6 h, every 6h; qd, every day; qod, every other day; bid, twice daily; qid, four times daily.
(Table adapted with permission from Linevsky JK, Kelly CP. Clostridium difficile colitis. In: Lamont JT, ed.Gastrointestinal infections: diagnosis and management. New York: Marcel Dekker, 1997:293–325).