Clostridium difficile diarrhoea is a common iatrogenic nosocomial disease. Fortunately, most affected patients respond well to medical therapy that includes discontinuation of the inciting antibiotic and treatment with metronidazole or vancomycin.1 However, despite successful treatment of initial episodes, 15–25% will have recurrence of diarrhoea following withdrawal of specific antibiotic therapy.1 ,2 Treatment of this form of C difficile disease can be particularly problematic.

Approaches to management include conservative therapy, treatment with specific anti-C difficile antibiotics, use of anion binding resins, therapy with microorganisms (probiotics), and immunoglobulin therapy (table 1).