9
S, strong ; W, weak; H, high; M, moderate; L, low; VL, very low quality of evidence;
GP, good practice; NR, no recommendation
➤ Antibiotic treatment options for patients with more than one recurrence
of CDI include (W-L):
• oral vancomycin therapy using a tapered and pulse regimen,
• a standard course of oral vancomycin followed by rifaximin, or
• fidaxomicin.
➤ Fecal microbiota transplantation (FMT) is recommended for patients
with multiple recurrences of CDI who have failed appropriate antibiotic
treatments (S-M).
➤ There are insufficient data at this time to recommend extending
the length of anti-C. difficile treatment beyond the recommended
treatment course or re-starting an anti-C. difficile agent empirically
for patients who require continued antibiotic therapy directed against
the underlying infection or who require re-treatment with antibiotics
shortly after completion of CDI treatment, respectively (NR).
Pediatric
➤ Either metronidazole or vancomycin is recommended for the
treatment of children with an initial episode or first recurrence of
non-severe CDI (see Table 4 for dosing) (W-L).
➤ For children with an initial episode of severe CDI, oral vancomycin is
recommended over metronidazole (S-M).
➤ For children with a second or greater episode of recurrent CDI, oral
vancomycin is recommended over metronidazole (W-L).
➤ Consider fecal microbiota transplantation (FMT) for pediatric patients
with multiple recurrences of CDI following standard antibiotic
treatments (W-VL).
