Infectious Diseases I
Clinical
Definition
ACG 2013
IDSA/SHEA 2018
2021 Focused Update
ACG 2021
Second
recurrence
Vancomycin
PO, then
28-day dosage
taper
Vancomycin in
tapered and pulsed
regimen
—OR—
Vancomycin 125 mg
PO 4 times daily
for 10 days, then
rifaximin 400 mg
TID for 20 days
—OR—
Fidaxomicin 200 mg
PO/NG/FT BID for
10 days —OR—
Fecal microbiota
transplantation
Fidaxomicin 200 mg PO/
NG/FT BID for 10 days—
OR—BID for 5 days, then
once every other day for
20 days
—OR—
Vancomycin PO in
tapered and pulsed
regimen
—OR—
Vancomycin 125 mg 4
times daily PO for 10
days, then rifaximin 400
mg TID for 20 days
—OR—
Fecal microbiota
transplantation (preferably
after 3 antibiotic courses
are attempted and
completed)
Adjunctive therapy:
Bezlotoxumab 10 mg/
kg IV once during
administration of above
antibiotics
Recommend
fecal microbiota
transplant (FMT)
to prevent further
recurrences (strong
recommendation,
moderate-quality
evidence)
Suggest bezlotoxumab
for high risk of
recurrence (conditional
recommendation,
moderate-quality
evidence)
ACG = American College of Gastroenterology; BID = twice daily; FT = feeding tube; IDSA = Infectious Diseases Society of America; IV = intravenously; NS = normal
saline; PO = orally; SHEA = Society for Healthcare Epidemiology of America; TID = 3 times daily.
Information from: Johnson S, Lavergne V, Skinner AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for
Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Inf Dis 2021. Available
at www.idsociety.org/globalassets/idsa/practice-guidelines/cdi-2021-focused-update.pdf. McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for
Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of
America (SHEA). Clin Infect Dis 2018;66:987-94. Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for Diagnosis, Treatment, and Prevention of Clostridium