Clostridium difficile - recurrence

Content version: U-294.2
Updated: 10/20/2025 - 13:06

Recommendations

≥ 18 years

Indications: Recurrent CDI
	Dosage	Remarks
1st choice	fidaxomicin oral 200 mg twice daily for 10 days	SWAB remarks 1st recurrence, after treatment with vancomycin.
1st choice	fidaxomicin oral 200 mg twice daily for 5 days followed by fidaxomicin oral 200 mg every 48 hours for 20 days	SWAB remarks 1st recurrence, after treatment with fidaxomicin: extended-pulsed regimen. Day 1–5: 200 mg twice daily; days 7–25: 200 mg once every other day.
1st choice alternative	vancomycin oral 250 mg four times daily for 2 weeks followed by vancomycin oral 250 mg twice daily for 1 week followed by vancomycin oral 250 mg once daily for 1 week	SWAB remarks 1st recurrence, after treatment with fidaxomicin: taper-and-pulse regimen.
		SWAB remarks 2nd and subsequent recurrences: in principle faecal microbiota transplantation; see guideline.

≥ 18 years

Indications: secondary prophylaxis
	Dosage	Remarks
	vancomycin oral 250 mg once daily or fidaxomicin oral 200 mg once daily	SWAB remarks For patients known to develop CDI in response to a known trigger, and for vulnerable patients in whom the risk of recurrent CDI for other reasons is high. Secondary prophylaxis should be used from the start of the precipitating factor until 5 days after cessation of that factor. Choice of agent in consultation with an infectious disease specialist / microbiologist.

Comments

Stop the causative antibiotic where possible, and isolate the patient.

2nd and later recurrences: in principle faecal microbiota transplantation; see SWAB guideline Acute diarrhoea for details