Do Patients with Initial Clostridioides difficile Infection Need Prolonged Vancomycin?

Clostridioides difficile infection (CDI) has a high rate of recurrence, an important limitation of available treatments. Recurrence rates are lower with fidaxomicin than vancomycin, but expense limits fidaxomicin availability. Investigators thus explored whether a prolonged course of vancomycin would reduce recurrence rates. They randomly assigned 265 patients (most with their first episode of CDI) to receive 2 weeks of standard-dose vancomycin either alone or followed by 2 weeks of a tapering dose. The primary outcome was recurrence between days 15 and 56 after starting treatment.