Table 2. Proposed Treatment for NAP1/B1/027 Strain.

IV: intravenous; IVIG: intravenous immunoglobulin; NAP1/BI/027: North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis type B1, polymerase chain reaction ribotype 027

	First line treatment	Alternative treatment
Initial non-severe infection	Oral vancomycin, 125 mg four times daily for 10 days	Fidaxomicin, 200 mg twice daily for 10 days; If neither is available, then use metronidazole, 500 mg three times daily for 10 days
First non-severe recurrence	Repeat oral vancomycin, 125 mg four times daily for 10 days	Fidaxomicin, 200 mg twice daily for 10 days
Second non-severe recurrence	Oral vancomycin taper as follow: 125 mg four times daily for seven to 14 days, 125 mg twice daily for seven days, 125 mg twice once daily for seven days, 125 mg once every other day for seven days, 125 mg once every three days for 14 days	Fidaxomicin, 200 mg orally twice daily for 10 days, or a fecal microbiota transplant
Subsequent non-severe recurrence	Fecal microbiota transplant	Tapering oral vancomycin with probiotics, IVIG, fidaxomicin
Severe disease	Oral vancomycin, 125 mg four times daily, increase to 500 mg four times daily if no improvement noted in 24-48 hours or associated complications, including renal failure, ileus, etc.	Fidaxomicin if the patient cannot tolerate oral vancomycin for any reason
Ileus	Add IV metronidazole, 500 mg every eight hours, to oral vancomycin or fidaxomicin therapy; consider general surgery consult as needed	Intracolonic vancomycin, IVIG