Friday Board Review

Gastrointestinal Board Review with Dr. Edward Guo

A 40 year old female who works as a nurse aide in a long term rehabilitation center presents for abdominal pain and diarrhea. She describes greater than 3 episodes of loose, watery stool for the past 2 days with no vomiting or fever. Her vital signs are within normal limits. A Clostridium difficile stool toxin PCR is sent and results positive. According to the 2021 Infectious Disease Society of America guidelines, what is the preferred treatment for her condition?

A: IV vancomycin

B: PO fidaxomicin

C: PO metronidazole

D: PO vancomycin

Answer: PO fidaxomicin

The most recent IDSA guidelines for the treatment of non-fulminant Clostridium difficile diarrhea is fidaxomicin. It has shown superiority in preventing recurrence of disease when compared to oral vancomycin. Oral vancomycin or oral metronidazole are acceptable alternatives in non-fulminant disease and generally cost less than fidaxomicin. IV vancomycin is not used in the treatment of C. difficile diarrhea.

Treatment of Clostridium Difficile Diarrhea in Adults
Initial, non-fulminantFidaxomicin preferred
PO vancomycin alternative
Recurrent, non-fulminantFidaxomicin or PO vancomycin
FulminantPO vancomycin or via NG tube and IV metronidazole


Stuart Johnson, Valéry Lavergne, Andrew M Skinner, Anne J Gonzales-Luna, Kevin W Garey, Ciaran P Kelly, Mark H Wilcox, Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults, Clinical Infectious Diseases, Volume 73, Issue 5, 1 September 2021, Pages e1029–e1044,

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