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Doxycycline pregnancy — GPhC CRA MCQ

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HardInfection ManagementDoxycycline pregnancyGPhC CRA

An 81-year-old completed oral vancomycin for a first episode of Clostridioides difficile infection and symptoms resolved. Six weeks later toxin-positive diarrhoea recurs, without ileus or life-threatening features. Which regimen is NICE first choice for this further episode?

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Correct answer: A — Fidaxomicin 200 mg orally twice daily for 10 days

A further episode within 12 weeks of symptom resolution is a relapse under NICE NG199. Fidaxomicin 200 mg twice daily for 10 days is first choice for this situation. Vancomycin is first line for an initial episode and may be considered for a recurrence occurring more than 12 weeks later, but is not the preferred answer here. Metronidazole is not the recommended regimen. Antimotility treatment can mask or worsen serious colitis. FMT is considered for recurrent disease after at least two previous episodes, not automatically after the first relapse.

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