Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease

Am J Gastroenterol. 2002 Jul;97(7):1769-75. doi: 10.1111/j.1572-0241.2002.05839.x.


Objective: There is currently uncertainty as to the best treatment for patients with recurrent episodes of Clostridium difficile disease (RCDD). Our objective was to evaluate the success of treatment strategies in a cohort of 163 RCDD patients.

Methods: Data were used from patients who had participated in the placebo arm in two national referral clinical trials evaluating a new combination treatment. Patients with active RCCD were enrolled, prescribed either vancomycin or metronidazole, and randomized to either the investigational biological or a placebo. All patients were observed for at least 2 months for a subsequent episode of RCCD.

Results: Of the 163 cases, 44.8% recurred. A tapering course of vancomycin resulted in significantly fewer recurrences (31%, p = 0.01), as did pulsed dosing of vancomycin (14.3%, p = 0.02). A trend (p = 0.09) for a lower recurrence frequency was observed for high-dose (> or =2 g/day) vancomycin and low-dose (< or =1 g/day) metronidazole. Vancomycin was significantly more effective in clearing C. difficile culture and/or toxin by the end of therapy than metronidazole (89% vs 59%, respectively; p < 0.001).

Conclusions: These data show that tapered or pulsed dosing regimens of vancomycin may result in a significantly better cure of RCDD. The persistence of C. difficile spores suggests that additional strategies to restore the normal colonic microflora may also be beneficial.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Clostridioides difficile*
  • Cohort Studies
  • Enterocolitis, Pseudomembranous / drug therapy*
  • Enterocolitis, Pseudomembranous / microbiology
  • Female
  • Humans
  • Male
  • Metronidazole / therapeutic use*
  • Middle Aged
  • Recurrence
  • Remission Induction
  • Risk Factors
  • Vancomycin / therapeutic use*


  • Anti-Bacterial Agents
  • Metronidazole
  • Vancomycin