Since the 2010s, the incidence of Clostridioides difficile infection (CDI) has been rising worldwide. In 2017, the Infectious Diseases Society of America recommended vancomycin and fidaxomicin, rather than metronidazole, as first-line therapies for initial CDI. In contrast, the 2024 Korean guidelines still recommend metronidazole over vancomycin for mild-to-moderate, low-risk cases. We examined national CDI treatment patterns in Korea from 2014 to 2023, focusing on metronidazole and vancomycin use, recurrence rates, and episode durations. Claims data from the Health Insurance Review & Assessment Service (HIRA) were analyzed with retreatment within 2 weeks defined as the same episode and within 2–8 weeks as recurrent CDI. CDI episodes increased from 16,068 in 2014 to 53,834 in 2023. Metronidazole-only treatment accounted for 66.3% of cases in 2014, but by 2023 vancomycin-only treatment rose to 39.6%, surpassing metronidazole-only (35.8%). Over 10 years, recurrence occurred in 6.3% of 73,010 vancomycin-only episodes compared with 4.7% of 143,375 metronidazole-only episodes. Mean episode duration was longer in the vancomycin group (20.1 vs. 13.7 days in mild cases; 27.3 vs. 23.4 days in severe cases). Prescription patterns over the past decade suggest an expanding role of vancomycin in CDI treatment in Korea. The recurrence rate and episode duration of each group may reflect clinical preference for vancomycin in higher-risk patients.