TABLE 4.

Treatment Options for Recurrent Clostridium difficile Infection

First recurrence

Mild to moderate C difficile infection (CDI)

Oral metronidazole, 500 mg 3 times a day for 14 d

Mild to moderate CDI (no response to oral metronidazole previously)

Severe CDI

Oral vancomycin, 125 mg 4 times a day for 14 d

Second recurrence

Oral vancomycin tapered over 6 wk

125 mg 4 times daily for 14 d

125 mg 2 times daily for 7 d

125 mg once daily for 7 d

125 mg once every other day for 8 d

125 mg once every 3 d for 15 d

Future recurrences

Oral vancomycin, 125 mg 4 times a day for 14 d, followed by rifaximin, 400 mg twice daily for 14 d

Consider fecal microbiota transplantation

Consider intravenous immunoglobulin, 400 mg/kg, repeated up to 3 times at 3-wk intervals

Consider combination therapy with oral vancomycin and oral rifaximin