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Recurrent C. difficile — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipRecurrent C. difficileSCE Infectious Diseases

Six weeks after completing treatment for a first CDI episode, an adult develops new toxin-positive diarrhoea but remains haemodynamically stable. Under NICE NG199, how does this interval determine the next antibacterial course?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: EFidaxomicin 200 mg orally twice daily for 10 days with planned follow-up for complications after review

The best answer is “Fidaxomicin 200 mg orally twice daily for 10 days with planned follow-up for complications after review”. A further episode within 12 weeks is treated with fidaxomicin at the stated dose; fulminant regimens, antibody monotherapy and prolonged suppressive courses do not match this stable recurrence. “Metronidazole 400 mg orally three times daily for 14 days” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Vancomycin 500 mg orally four times daily plus intravenous metronidazole” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Bezlotoxumab alone without an antibacterial” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “A 6-month continuous course of vancomycin 125 mg daily” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement.

Reference: NICE NG199 Clostridioides difficile recommendations: https://www.nice.org.uk/guidance/ng199/chapter/Recommendations