What is the most appropriate action when a Clostridium difficile infection recurs after treatment?

In cases of recurrent Clostridium difficile infection (CDI), the most appropriate action involves administering vancomycin. This treatment choice is supported by clinical guidelines which recommend using vancomycin for recurrence, especially after initial courses of metronidazole have failed.

Recurrences of CDI often require different management approaches than initial infections. Metronidazole was previously a standard treatment, but its efficacy for recurrence is limited and may not be as effective as vancomycin. Therefore, instead of repeating metronidazole, the more appropriate course is to administer vancomycin.

Probiotics, while sometimes considered for prevention rather than treatment, do not have consistent evidence supporting their efficacy in treating a recurrence of CDI. Rifaximin is an antibiotic that is not effective against CDI and is unsuitable for treating the infection directly.

In summary, for a recurrent Clostridium difficile infection, the recommended action is to use vancomycin, as it has been shown to be more effective in eradicating recurrent infections compared to repeating metronidazole or using other treatments.