Oral Vancomycin as Secondary Prophylaxis for Prevention of Recurrent Clostridioides difficile Infection

This Clinical Decisions piece presents a vignette of a 72-year-old woman with quadriplegia, neurogenic bladder, and recent nonsevere C. difficile infection treated with fidaxomicin. On admission for a new UTI, clinicians must decide whether to initiate oral vancomycin prophylaxis alongside systemic antibiotics to prevent recurrence. Two expert commentaries follow: one recommends prophylaxis based on retrospective studies, guideline updates, and individual patient risk factors; the other warns against it due to microbiome disruption, lack of randomized trials, and questionable long-term benefit. The article emphasizes individualized decision-making while awaiting stronger evidence.

This Clinical Decisions piece presents a vignette of a 72-year-old woman with quadriplegia, neurogenic bladder, and recent nonsevere C. difficile infection treated with fidaxomicin. On admission for a new UTI, clinicians must decide whether to initiate oral vancomycin prophylaxis alongside systemic antibiotics to prevent recurrence. Two expert commentaries follow: one recommends prophylaxis based on retrospective studies, guideline updates, and individual patient risk factors; the other warns against it due to microbiome disruption, lack of randomized trials, and questionable long-term benefit. The article emphasizes individualized decision-making while awaiting stronger evidence.