Treatment of second recurrence of CDI

Antimicrobial prescribing: NHS Lothian
NHS Lothian
See Overview for overall care and management.
Treatment may not be required if the patient has an equivocal C. difficile result (see Equivocal result). If ongoing symptoms (e.g. diarrhoea), consider repeat testing and seek infection specialist advice as appropriate.

Review severity markers (see Severity of Infection) and contact infection specialist for advice (see How to get advice).

Faecal microbiota transplant (FMT) is recommended and requires referral to infectious diseases - bleep 8161.

If FMT not available considering tapering oral vancomycin regime as below:

Tapering vancomycin course

Week 1 - Vancomycin 125mg every 6 hours

Week 2 - Vancomycin 125mg every 12 hours

Week 3 - Vancomycin 125mg daily

Week 4 - Vancomycin 125mg alternate days

Week 5 - Vancomycin 125mg every third day

If further recurrences specialist advice is required (see How to get advice).

Editorial Information

Last reviewed: 01/06/2026

Next review date: 01/06/2029

Version: 3.0

Approved By: Antimicrobial Management Committee