American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the appropriate treatment for a patient experiencing a second recurrence of Clostridium difficile infection?

1. Oral vancomycin at standard doses for 2 weeks

2. Oral vancomycin given at tapered doses over 6 to 8 weeks

3. Intravenous antibiotics for 4 weeks

4. No treatment is necessary

The correct answer is: Oral vancomycin given at tapered doses over 6 to 8 weeks

In the case of a patient experiencing a second recurrence of Clostridium difficile infection, the appropriate treatment involves administering oral vancomycin with a tapered dosing strategy over a period of 6 to 8 weeks. This approach is grounded in the understanding that recurrence of C. difficile infection can result from a failure to eradicate the organism completely during the initial treatment courses or due to factors related to the host's microbiome. Tapering the dosage of vancomycin allows for more prolonged exposure to the antibiotic while gradually reducing the amount administered over time. This method can help suppress the growth of the bacteria while simultaneously allowing the patient’s gut microbiota a chance to recover. The tapering schedule reduces the risk of re-colonization and thereby lowers the chance of further recurrences. Using standard doses for just 2 weeks may not provide adequate duration of therapy against recurrent infections since the standard regimen may not sufficiently prevent recurrence after a second episode. Intravenous antibiotics are not an appropriate choice for treating C. difficile infections, as this infection is primarily treated with oral therapy, which achieves higher concentrations in the gut where the C. difficile bacteria reside. Lastly, assuming no treatment is necessary can lead to further complications, as untreated recurrences can significantly affect