The treatment strategies for CDI include discontinuing antibiotics as soon as possible, as this may influence the risk of CDI recurrence.

Recommendations for the Treatment of Clostridium difficile Infection in Adults

Etology	Primary Regimen	Alternate Regimen
Initial episode, non-severe : Leukocytosis with a white blood cell (WBC) count of ≤15 000 cells/mL and a serum creatinine level <1.5 mg/dL	VAN 125 mg given 4 times daily for 10 days	Oral Vancomycin is not available - metronidazole, 400 mg 3 times per day by mouth for 10 days
Xpert C. difficile assay (Xpert CD assay; Cepheid )	VAN, 125 mg 4 times per day by mouth for 10 days
Initial episode, fulminant : Hypotension or shock, ileus, megacolon	VAN, 500 mg 4 times per day by mouth or by nasogastric tube. If ileus, consider adding rectal instillation of VAN. Intravenously administered metronidazole (500 mg every 8 hours) should be administered together with oral or rectal VAN, particularly if ileus is present
First recurrence	• VAN 125 mg given 4 times daily for 10 days if metronidazole was used for the initial episode.	Use a prolonged tapered and pulsed VAN regimen if a standard regimen was used for the initial episode (eg, 125 mg 4 times per day for 10–14 days, 2 times per day for a week, once per day for a week, and then every 2 or 3 days for 2–8 weeks).
Second or subsequent recurrence	VAN in a tapered and pulsed regimen • VAN, 125 mg 4 times per day by mouth for 10 days followed by rifaximin 400 mg 3 times daily for 20 days.	• Faecal microbiota transplantation

Abbreviations: VAN =Vancomycin

1. All randomized trials have compared 10-day treatment courses, but some patients (particularly those treated with metronidazole) may have delayed response to treatment and clinicians should consider extending treatment duration to 14 days in those circumstances.
2. The opinion of the panel is that appropriate antibiotic treatment for at least 2 recurrences (ie, 3 CDI episodes) should be tried prior to offering faecal microbiota transplantation.

If surgical management is necessary for severely ill patients, perform subtotal colectomy with preservation of the rectum. Diverting loop ileostomy with colonic lavage followed by antegrade vancomycin flushes is an alternative approach that may lead to improved outcomes. For children with an initial episode of severe CDI, oral Vancomycin is recommended over metronidazole. There are insufficient data at this time to recommend the administration of probiotics for primary prevention of CDI outside of clinical trials