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Post-CDI Antibiotic Stewardship — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipPost-CDI Antibiotic StewardshipSCE Infectious Diseases

A 50-year-old man develops a hospital-acquired Clostridioides difficile infection while on Ciprofloxacin for a UTI. After successful treatment with oral Vancomycin, what antibiotic stewardship measure should be implemented to prevent recurrence?

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Correct answer: B — Review and rationalise all concurrent antibiotics — stop or narrow the precipitating antibiotic (Ciprofloxacin) as soon as clinically appropriate; avoid fluoroquinolones and cephalosporins in future where possible

Ongoing broad-spectrum antibiotic exposure (particularly fluoroquinolones and cephalosporins) is the strongest modifiable risk factor for CDI recurrence. The most important stewardship intervention after CDI is reviewing and stopping/narrowing the precipitating antibiotic. Future antibiotic prescriptions should preferentially use low-CDI-risk agents (Nitrofurantoin, Trimethoprim, Doxycycline, Pivmecillinam) where clinically appropriate. This principle of 'antibiotic guardian' care post-CDI applies to all subsequent prescribing decisions.

Reference: NICE NG199 2021 – CDI; NICE NG15 – Antimicrobial stewardship; UKHSA 2024