According to the 2021 IDSA/SHEA guidelines, what is the recommended treatment for a first recurrent episode of non-severe Clostridioides difficile infection?

The recommended treatment for a first recurrent episode of non-severe Clostridioides difficile infection, according to the 2021 IDSA/SHEA guidelines, is fidaxomicin 200 mg by mouth every 12 hours for 10 days. This choice is based on evidence demonstrating that fidaxomicin has a superior efficacy for reducing recurrence rates compared to vancomycin, particularly in cases of recurrent infections. Fidaxomicin’s narrow spectrum of activity primarily targets C. difficile, leading to preservation of the normal gut flora and resulting in fewer recurrences.

Additionally, fidaxomicin has a higher sustained clinical response and has been shown to minimize the impact on the microbiome compared to vancomycin. This makes it particularly beneficial for patients with recurrent episodes, as it not only addresses the current infection but also helps prevent future recurrences by promoting a healthier gut environment.

The other options provided are less aligned with the guidelines for this specific scenario. For instance, while vancomycin is effective for initial infections, its routine use in recurrent infections tends to be less effective than fidaxomicin in preventing recurrences. Rectal vancomycin retention enemas and fecal microbiota transplant are generally reserved for cases that