American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment protocol for a second recurrence of non-fulminant C. diff?

1. Continue the same regimen of Metronidazole

2. Start Vancomycin pulsed-tapered regimen

3. Switch to oral Fidaxomicin

4. All of the above

The correct answer is: All of the above

In managing a second recurrence of non-fulminant Clostridioides difficile (C. diff) infection, the treatment protocol often involves several effective options, all of which are represented in the choices. Continuing with Metronidazole is sometimes considered, although current guidelines have shifted toward using Vancomycin more prominently due to concerns about treatment failure and the development of resistance. However, it can still be part of a treatment plan based on the patient's history and clinician preferences. The Vancomycin pulsed-tapered regimen is specifically recommended for recurrent C. diff infections. This approach involves administering the antibiotic at reduced doses and intervals, which can help eradicate the infection while minimizing the risk of recurrence. This strategy has shown to be beneficial in patients who have multiple recurrences. Switching to oral Fidaxomicin is also an appropriate strategy. Fidaxomicin has been found to have a lower risk of recurrence compared to Vancomycin, particularly in patients who have previously been treated with Vancomycin but continue to experience recurrences. Each of these treatments offers mechanisms to address C. diff recurrence while taking into account factors such as antibiotic resistance and individual patient response. Therefore, all these treatment strategies are valid options