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Patients with refractory or recurrent Clostridium difficile infection (CDI) often need courses of antibiotics months or years after CDI is cured. Should prophylactic oral vancomycin or metronidazole also be given, to prevent yet another CDI recurrence? No guidelines support this practice, yet many providers are sorely tempted to try it.
Canadian researchers retrospectively reviewed the cases of 551 patients with histories of recent CDI who were started subsequently on other antibiotics. Compared with 324 patients who did not receive prophylactic vancomycin, 227 who did were more likely to have had at least one previous CDI relapse (40% vs. 25%) and to have received vancomycin for initial treatment (84% vs. 50%). Most prophylactic courses wer…