From the Guidelines
For the treatment of Clostridioides difficile infection (CDI), fidaxomicin 200 mg given twice daily for 10 days is the preferred initial treatment, as it has been shown to be effective in reducing recurrence rates and improving clinical outcomes, as recommended by the 2021 focused update guidelines by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1.
Treatment Approach
The approach to treating CDI depends on the severity of the infection, with different treatment options available for initial episodes, recurrences, and fulminant cases.
- For an initial CDI episode, the preferred treatment is fidaxomicin 200 mg twice daily for 10 days, with vancomycin 125 mg four times daily for 10 days being an acceptable alternative 1.
- For recurrent CDI, the preferred treatment is fidaxomicin 200 mg twice daily for 10 days, or vancomycin in a tapered and pulsed regimen, with consideration of adjunctive treatment with bezlotoxumab 10 mg/kg given intravenously once during administration of standard of care antibiotics 1.
- For fulminant CDI, the recommended treatment is vancomycin 500 mg four times daily by mouth or by nasogastric tube, with consideration of adding rectal instillation of vancomycin and intravenously administered metronidazole 500 mg every 8 hours 1.
Prevention and Management
Prevention of CDI includes proper hand hygiene with soap and water, contact precautions for infected patients, and antimicrobial stewardship to limit unnecessary antibiotic use.
- Fecal microbiota transplantation may be considered for patients with multiple recurrences of CDI, but should only be offered after appropriate antibiotic treatments have been tried 1.
- Bezlotoxumab may also be considered for patients with other risks for CDI recurrence, but its use should be weighed against the potential risks, particularly in patients with a history of congestive heart failure 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Clostridioides difficile-Associated Diarrhea DIFICID® is indicated in adult and pediatric patients aged 6 months and older for the treatment of C. difficile-associated diarrhea (CDAD).
C. difficile (C.diff) Treatment: Fidaxomicin (DIFICID) is indicated for the treatment of C. difficile-associated diarrhea (CDAD) in adults and pediatric patients aged 6 months and older 2.
- Key Points:
- Fidaxomicin is used to treat CDAD.
- It is approved for use in adults and pediatric patients aged 6 months and older.
- The medication should only be used to treat infections proven or strongly suspected to be caused by C. difficile.
From the Research
Overview of C.diff
- C.difficile infection is a major cause of infectious diarrhea in hospitals and communities 3, 4
- The infection can range from mild diarrhea to fulminant infection requiring intensive care admission 3
Treatment Options
- Fidaxomicin and vancomycin are the preferred treatments for a first episode of C.difficile infection 3, 4, 5
- Metronidazole is not recommended for primary C.difficile infection, except in mild-to-moderate disease in younger patients with no or few risk factors for recurrence 4
- Bezlotoxumab, a monoclonal antibody, can be used to prevent recurrences in patients at high risk 3, 4, 5
- Fecal microbiota transplantation (FMT) is an effective treatment for recurrent C.difficile infection, with a success rate of over 85% 3, 6
Management of Recurrent C.difficile Infection
- Vancomycin taper and pulse or fidaxomicin can be used to manage a first recurrence of C.difficile infection 3, 4
- FMT can be offered to patients with frequently recurring C.difficile infection 4, 6
- Microbiome-based therapies, such as live biotherapeutics, are also available for prevention of recurrent C.difficile infection 5