Vancomycin taper: gradual dose reduction reduces rebound CDI after discontinuation
Bezlotoxumab: neutralizes toxin B, reducing recurrence by ~40% relative risk in high-risk patients
FMT: restores colonization resistance via donor microbiome; most effective strategy for multiply recurrent CDI
Microbiota-based therapeutics
Rebyota (fecal microbiota live-jslm): FDA-approved 2022; single rectal administration
Vowst (fecal microbiota spores live-brpk): FDA-approved 2023; oral capsules for 3 consecutive days
Both indicated for prevention of recurrence in adults after antibiotic completion
Surgical decision-making
Early surgical consultation is key — waiting until maximal medical failure worsens outcomes
Diverting loop ileostomy with colonic lavage emerging as colon-preserving alternative to colectomy
Mortality benefit of DLI vs colectomy still under evaluation but ostomy reversal rates superior
Infection prevention
Antimicrobial stewardship: most effective prevention measure
Contact precautions and environmental disinfection with sporicidal agents (bleach-based)
Hand hygiene with soap and water mandatory (spores not killed by alcohol)
Probiotics not recommended by IDSA for CDI prevention
PPI deprescribing where appropriate reduces recurrence risk
Patient Discharge Instructions
copy discharge instructions
Diagnosis and treatment instructions
You have been diagnosed with a Clostridioides difficile (C. diff) infection — a bacterial infection of the colon caused by recent antibiotic use
Take your prescribed antibiotic exactly as directed for the full course
Do not stop your medication early even if you feel better
Finish all of your medication before resuming any probiotics
Antibiotic and medication guidance
If prescribed vancomycin capsules: take by mouth, not intravenously
If prescribed fidaxomicin: take one tablet twice daily with or without food
Do not take anti-diarrhea medications like loperamide (Imodium) unless your doctor specifically approves
Avoid unnecessary antibiotics in the future — discuss with your doctor before taking any antibiotic
Speak with your doctor about stopping your proton pump inhibitor (e.g., omeprazole) if it may not be needed
Hygiene and prevention
Wash your hands thoroughly with soap and water after using the toilet — hand sanitizer does not kill C. diff spores
Wash your hands with soap and water before eating and preparing food
Clean bathroom surfaces regularly with a bleach-based cleaner while you are still having symptoms
Do not share towels, utensils, or personal care items with household contacts
Household members should wash their hands with soap and water after contact with your environment
Expected recovery course
Diarrhea typically improves within 3–5 days of starting treatment
Complete resolution of symptoms may take up to 2 weeks
You may continue to test positive for C. diff for weeks after treatment — this is normal, do not re-test unless symptoms return
Post-infectious bowel symptoms (bloating, irregular stool) may persist for several weeks after recovery
Diet and hydration
Drink plenty of fluids to replace losses from diarrhea
Oral rehydration solutions (e.g., Pedialyte, electrolyte drinks) are helpful
Eat small, frequent meals as tolerated
Avoid alcohol during your antibiotic course
Follow-up instructions
Follow up with your family doctor or gastroenterologist within 1–2 weeks
If you have had multiple C. diff infections, ask your doctor about a referral to a gastroenterologist to discuss fecal microbiota transplant
Do not request a repeat stool test unless diarrhea returns — a positive test without symptoms does not require treatment
Return to emergency department — seek immediate care for
Diarrhea returning or worsening (≥3 watery stools per day) after initial improvement
Fever, severe abdominal pain, or abdominal distension
Blood in your stool
Inability to keep fluids down or signs of dehydration (decreased urination, dizziness, dry mouth)
Feeling very unwell, lightheaded, or confused
References
Guidelines and key sources
ACG Clinical Guidelines 2021
Kelly CR, Fischer M, Allegretti JR, et al. ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides Difficile Infections. American Journal of Gastroenterology. 2021
doi: 10.14309/ajg.0000000000001278
IDSA/SHEA 2021 Focused Update
Johnson S, Lavergne V, Skinner AM, et al. Clinical Practice Guideline by IDSA and SHEA: 2021 Focused Update Guidelines on Management of Clostridioides Difficile Infection in Adults. Clinical Infectious Diseases. 2021
doi: 10.1093/cid/ciab549
ASCRS Clinical Practice Guidelines 2021
Poylin V, Hawkins AT, Bhama AR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides Difficile Infection. Diseases of the Colon and Rectum. 2021
doi: 10.1097/DCR.0000000000002047
ESCMID Guidelines 2021
van Prehn J, Reigadas E, Vogelzang EH, et al. ESCMID: 2021 Update on the Treatment Guidance Document for Clostridioides Difficile Infection in Adults. Clinical Microbiology and Infection. 2021
PMID: 34678515
WSES Guidelines 2019 (Surgical Patients)
Sartelli M, Di Bella S, McFarland LV, et al. 2019 Update of the WSES Guidelines for Management of Clostridioides Difficile Infection in Surgical Patients. World Journal of Emergency Surgery. 2019
PMC: 6394026
Key trials and systematic reviews
FMT Cochrane Review 2023
Minkoff NZ, Aslam S, Medina M, et al. Fecal Microbiota Transplantation for the Treatment of Recurrent Clostridioides Difficile. Cochrane Database of Systematic Reviews. 2023
doi: 10.1002/14651858.CD013871.pub2
Recurrence prognostic factors review 2022
van Rossen TM, Ooijevaar RE, Vandenbroucke-Grauls CMJE, et al. Prognostic Factors for Severe and Recurrent CDI: Systematic Review. Clinical Microbiology and Infection. 2022
PMID: 34655745
DLI vs colectomy analysis 2026
Zangbar B, Mehta R, Kirsch J, et al. Diverting Loop Ileostomy With Antegrade Colonic Lavage Compared With Colectomy in CDI Colitis: Decade-Long Propensity Score-Matched Analysis. Journal of Trauma and Acute Care Surgery. 2026
Clarke LM, Allegretti JR. The epidemiology and management of Clostridioides difficile infection — a clinical update. Alimentary Pharmacology and Therapeutics. 2024
doi: 10.1111/apt.17975
Diagnosis systematic review 2023
Manzoor F, Manzoor S, Pinto R, et al. Does This Patient Have Clostridioides Difficile Infection? Systematic Review and Meta-Analysis. Clinical Microbiology and Infection. 2023
PMID: 37327874
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.