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Recurrent CDI — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesRecurrent CDIRACP Adult Medicine

A 72-year-old man admitted with pneumonia develops Clostridioides difficile infection. He is on his third recurrence despite standard vancomycin tapered and pulsed regimens. What is the most effective treatment for multiply recurrent CDI?

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Correct answer: D — Faecal microbiota transplantation (FMT)

For multiply recurrent CDI (≥2 recurrences despite appropriate antibiotic regimens), faecal microbiota transplantation (FMT) is the most effective intervention, with cure rates of 85–90% after a single procedure. It restores the normal colonic microbiome that prevents C. difficile colonisation. FMT is delivered via colonoscopy, nasogastric tube, or capsules. Bezlotoxumab (anti-toxin B monoclonal antibody) is an adjunctive therapy to reduce recurrence when given with standard antibiotics.

Reference: eTG – 2025 – Antibiotic Guidelines; IDSA/SHEA – 2021 – CDI Guidelines