For the treatment of initial episodes of Clostridium difficile infection; mild cases, if no response or intolerance to an adequate trial of oral metronidazole*: *As defined by the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection, 2018. Notes: - Metronidazole 500mg orally three times daily for 10-14 days can be used in patients with mild diarrhea. - Discontinue antibiotics for other indications if possible. - Higher doses of vancomycin have not been shown to be beneficial. - There is no evidence to support combination therapy with metronidazole or fidaxomicin. Maximum funded dose: Vancomycin 125mg four times daily, up to 14 days Maximum funded quantity: 56 capsules

For the treatment of initial episodes of Clostridium difficile infection; moderate or severe, uncomplicated cases*: *As defined by the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection, 2018. Notes: - Metronidazole 500mg orally three times daily for 10-14 days can be used in patients with mild diarrhea. - For mild to moderate cases, treatment should only be continued beyond 7 days if diarrhea persists, up to a maximum of 14 days. - Severe, uncomplicated cases should be treated for 10-14 days. There is no evidence to support treatment durations beyond 14 days. - Higher doses of vancomycin have not been shown to be beneficial. - There is no evidence to support combination therapy with metronidazole or fidaxomicin. Maximum funded dose: Vancomycin 125mg four times daily, up to 14 days Maximum funded quantity: 56 capsules

For the treatment of recurrent Clostridium difficile infection (CDI), first recurrence, mild to moderate* or severe, uncomplicated* cases: *As defined by the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection, 2018. Notes: - Recurrent CDI is defined as the reoccurrence of CDI within 8 weeks following the onset of a previous episode which resolved with treatment. - Treatment should only be continued for 14 days. - Higher doses or longer treatment duration with vancomycin have not been shown to be beneficial. - There is no evidence to support combination therapy with metronidazole or fidaxomicin. Maximum funded dose: Vancomycin 125mg four times daily, up to 14 days Maximum funded quantity: 56 capsules

For the treatment of recurrent Clostridium difficile infection (CDI), second or subsequent recurrences, mild to moderate* or severe, uncomplicated* cases: *As defined by the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection, 2018. Notes: - Recurrent CDI is defined as the reoccurrence of CDI within 8 weeks following the onset of a previous episode which resolved with treatment. - There is no evidence to support combination therapy with metronidazole or fidaxomicin. Funded dose: Vancomycin 125mg four times daily for 10-14 days, followed by vancomycin taper. Maximum funded quantity: 114 capsules