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Recurrent Clostridium difficilediarrhoea
  1. L Kyne,
  2. C P Kelly
  1. Harvard Medical School, Gerontology and Gastroenterology Divisions, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
  1. C P Kelly.ciaran_kelly{at}

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Clostridium difficile diarrhoea is a common iatrogenic nosocomial disease. Fortunately, most affected patients respond well to medical therapy that includes discontinuation of the inciting antibiotic and treatment with metronidazole or vancomycin.1 However, despite successful treatment of initial episodes, 15–25% will have recurrence of diarrhoea following withdrawal of specific antibiotic therapy.1 ,2 Treatment of this form of C difficile disease can be particularly problematic.

Approaches to management include conservative therapy, treatment with specific anti-C difficile antibiotics, use of anion binding resins, therapy with microorganisms (probiotics), and immunoglobulin therapy (table 1).

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Table 1

Approach to management of recurrent Clostridium difficile diarrhoea

First recurrence


Conservative management of recurrent diarrhoea is preferable to retreatment with metronidazole or vancomycin as these agents perpetuate disturbance of the normal intestinal flora predisposing patients to further recurrences.2 However, it is often difficult to withhold antibiotic therapy as many patients with recurrent disease are not able to tolerate ongoing diarrhoea. Persistent or worsening …

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