Prevention of Clostridioides difficile infection recurrence

High risk of recurrent Clostridioides difficile infection after completion of primary therapy. Standard approaches: bezlotoxumab, fidaxomicin, faecal microbiota therapy. Probiotics are discussed as an adjunct with limited evidence.

ICD-10 A04.71 drug

Also known as: Prevention of recurrent CDI

Drugs used for this condition

CProbiotics (Lactobacillus spp., Bifidobacterium spp., Saccharomyces boulardii)Case-by-case decision · Probiotic microorganismsCochrane 2017 showed a reduction in CDI on antibiotic therapy with probiotic use. However, ACG 2021 and AGA 2020 do not give an unambiguous recommendation – results are inconsistent across strains, and probiotic-associated bacteraemia risk exists in immunocompromised patients. Standard recurrent CDI therapy: fidaxomicin, faecal microbiota therapy, bezlotoxumab.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit