Clostridioides difficile Infection — ESEGH MCQ

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ModerateClostridioides difficile InfectionClostridioides difficile InfectionESEGH

A 58-year-old with recurrent Clostridioides difficile infection after two previous episodes asks about treatment options. Which of the following may be considered at this stage?

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Correct answer: A — Faecal microbiota transplant

After two or more recurrences of CDI, NICE NG199 explicitly recommends considering faecal microbiota transplant (FMT). This recommendation is supported by the updated BSG/HIS FMT guidelines (2024), which review growing evidence from national registries. FMT restores gut microbiota diversity and colonisation resistance, addressing the underlying pathophysiology of recurrent disease. Chronic vancomycin is not recommended as indefinite maintenance due to lack of evidence and risk of adverse effects. Metronidazole is inferior to vancomycin and has no role in maintenance. Probiotics alone lack robust evidence. Colonoscopy is diagnostic, not therapeutic. FMT is the evidence-based intervention for this clinical scenario in UK practice.

Reference: NICE NG199 Clostridioides difficile infection: antimicrobial prescribing – Recommendations (https://www.nice.org.uk/guidance/ng199/chapter/Recommendations); BSG/HIS Faecal Microbiota Transplantation Guidelines, 2nd edition (June 2024)