From the Guidelines
For the treatment of Clostridium difficile (C. diff) infection, oral vancomycin 125 mg four times daily for 10 days or fidaxomicin 200 mg twice daily for 10 days is recommended for initial episodes, as these regimens have been shown to be effective in reducing morbidity and mortality. The choice between vancomycin and fidaxomicin should be based on the severity of the infection and the patient's underlying health conditions. For example, fidaxomicin may be preferred for patients with a high risk of recurrence or those who have failed previous treatment with vancomycin 1.
In cases of recurrent C. diff infection, treatment with oral vancomycin as a tapered and pulsed-dose regimen or fidaxomicin may be effective, with fidaxomicin showing a lower rate of recurrence compared to vancomycin in some studies 1. Fecal microbiota transplantation (FMT) is also a viable option for patients with multiple recurrences, with a high degree of success in correcting intestinal dysbiosis and resolving symptoms 1.
Prevention of C. diff infection is crucial, and proper hand hygiene with soap and water, contact precautions for infected patients, and antimicrobial stewardship to limit unnecessary antibiotic use are essential measures. It is also important to note that C. diff spreads through fecal-oral transmission, typically after antibiotic use disrupts normal gut flora, allowing C. diff to proliferate and produce toxins that damage the intestinal lining 2.
Some key points to consider in the treatment and prevention of C. diff infection include:
- The importance of proper diagnosis and treatment of initial episodes to prevent recurrence
- The need for careful consideration of the choice of antibiotic regimen, taking into account the severity of the infection and the patient's underlying health conditions
- The potential benefits and risks of FMT, including the need for careful donor selection and screening
- The importance of prevention measures, including hand hygiene, contact precautions, and antimicrobial stewardship, to reduce the risk of transmission and infection.
Overall, the goal of treatment and prevention of C. diff infection should be to reduce morbidity and mortality, while also improving quality of life for affected patients. This can be achieved through a combination of effective treatment regimens, careful consideration of patient-specific factors, and rigorous prevention measures.
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).
Treatment of C. difficile-associated diarrhea (CDAD): Fidaxomicin (DIFICID) is indicated for the treatment of CDAD in adult and pediatric patients aged 6 months and older 3.
- Key points: + Fidaxomicin is used to treat CDAD. + It is indicated for adults and pediatric patients aged 6 months and older.
From the Research
Overview of C diff
- C diff, also known as Clostridioides difficile infection, is a significant healthcare-associated infection strongly associated with antibiotic use 4.
- The infection can have life-threatening complications and a substantial impact on healthcare costs 5.
Diagnosis and Treatment
- Practice guidelines for CDI have been revised to incorporate updated recommendations for diagnosis, treatment, and prevention 4.
- Vancomycin and fidaxomicin are now recommended as first-line therapy for most cases of CDI, while metronidazole is no longer advised for management of outpatient CDI 4, 6.
- Fecal microbiota transplant is effective and safe for the treatment of recurrent CDI 4, 6, 5.
Prevention of Recurrent CDI
- Bezlotoxumab, a monoclonal antibody, is available to prevent recurrences of CDI 6, 7.
- Fidaxomicin and bezlotoxumab have been shown to be effective in preventing recurrent CDI, but the costs associated with these therapies may limit their use 4, 7.
- Live biotherapeutic products are also available for the prevention of recurrent CDI 6, 5.
Comparison of Treatment Options
- A study comparing fidaxomicin and oral vancomycin in the treatment of recurrent CDI found no difference in CDI recurrence, re-infection rate, treatment failure, infection-related length of stay, or in-hospital all-cause mortality 8.
- Bezlotoxumab has been shown to reduce the risk of recurrent CDI in patients receiving metronidazole, vancomycin, or fidaxomicin for treatment of CDI 7.