Infectious Diseases I
Clinical
Definition
ACG 2013
IDSA/SHEA 2018
2021 Focused Update
ACG 2021
First
recurrence
Same regimen
as used for
initial episode,
unless severe;
if severe,
vancomycin
should be used
Vancomycin 125
mg 4 times daily
for 10 days if
metronidazole was
used for initial
episode
—OR—
Prolonged tapered
and pulsed
vancomycin
regimen if standard
regimen was used
for initial episode;
for example: 125
mg 4 times daily for
10–14 days, BID for
1 wk, once daily for
1 wk, then every 2
or 3 days for 2–8 wk
—OR—
Fidaxomicin
200 mg PO/NG/
FT BID for 10 days
if vancomycin was
used for initial
episode
Fidaxomicin 200 mg PO/
NG/FT BID for 10 days—
OR—BID for 5 days, then
once every other day for
20 days
Alternative: Vancomycin
PO in tapered and pulsed
regimen
—OR—
Vancomycin 125 mg
given 4 times daily PO for
10 days
Adjunctive therapy:
Bezlotoxumab 10 mg/
kg IV once during
administration of above
antibiotics
Recommend
fidaxomicin for first
recurrence after initial
course of vancomycin
or metronidazole
(conditional
recommendation,
moderate-quality
evidence)
Suggest tapering/pulsed
dose vancomycin first
recurrence after initial
course of fidaxomicin,
vancomycin, or
metronidazole (strong
recommendation, very
low-quality evidence)
Suggest bezlotoxumab
for high risk of
recurrence (conditional
recommendation,
moderate-quality
evidence)