Clostridium difficile is confirmed by toxin EIA in a hospitalized patient who has received broad-spectrum antibiotics. He has 10 watery stools per day but is hemodynamically stable. What is the first-line treatment according to current IDSA guidelines?
- A Oral metronidazole 500 mg TID for 10–14 days
- B Oral vancomycin 125 mg QID for 10 days or fidaxomicin 200 mg BD for 10 days ✓
- C Intravenous vancomycin alone
- D Fecal microbiota transplantation as first-line
Correct answer: B. Oral vancomycin 125 mg QID for 10 days or fidaxomicin 200 mg BD for 10 days
Explanation
Current IDSA/SHEA 2021 guidelines recommend oral vancomycin (125 mg QID × 10 days) or fidaxomicin (200 mg BD × 10 days) as first-line for all CDI episodes, including non-severe disease; fidaxomicin has lower recurrence rates. Metronidazole is no longer preferred for initial treatment due to inferior efficacy. IV vancomycin achieves negligible colonic concentrations. FMT is reserved for recurrent CDI after multiple antibiotic failures.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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