Table 1

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).