From the Guidelines
The treatment of Clostridioides difficile infection (CDI) is dependent on the clinical presentation, with specific recommendations for the dose and length of course of antibiotics, as outlined in the 2021 focused update guidelines by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. The guidelines provide recommendations for the treatment of CDI in adults, including initial episodes, recurrences, and fulminant cases.
- For initial CDI episodes, the preferred treatment is fidaxomicin 200 mg given twice daily for 10 days, or vancomycin 125 mg given 4 times daily by mouth for 10 days 1.
- The length of treatment is typically 10 days, but may be extended to 14 days for non-severe CDI, or modified for recurrent or fulminant cases 1. Key considerations in the treatment of CDI include:
- The use of vancomycin in a tapered and pulsed regimen for recurrent cases, or as an alternative to fidaxomicin for initial episodes 1.
- The potential for adjunctive treatment with bezlotoxumab 10 mg/kg given intravenously once during administration of standard of care antibiotics, particularly for patients with risk factors for recurrence 1.
- The importance of considering the clinical presentation, including severity and recurrence, when selecting a treatment regimen for CDI 1.
From the FDA Drug Label
12.2 Pharmacodynamics Fidaxomicin acts locally in the gastrointestinal tract on C. difficile. In a dose-ranging trial (N=48) of fidaxomicin using 50 mg, 100 mg, and 200 mg twice daily for 10 days, a dose-response relationship was observed for efficacy.
The treatment of C. difficile with fidaxomicin is dose-dependent, as a dose-response relationship was observed in a dose-ranging trial. The length of the course of treatment is specified as 10 days in the trial.
From the Research
C. difficile Treatment
The treatment of C. difficile infection (CDI) can vary depending on the severity and episode number of the infection.
- Fidaxomicin and vancomycin are two commonly used antibiotics for the treatment of CDI 2, 3, 4, 5, 6.
- The efficacy of these antibiotics can depend on the dose and length of the treatment course.
Dose and Length of Treatment Course
- A study comparing fidaxomicin with vancomycin for the treatment of CDI found that fidaxomicin (200 mg twice daily) was noninferior to vancomycin (125 mg four times daily) for 10 days in achieving clinical cure 2.
- Another study found that fidaxomicin and vancomycin had similar rates of clinical cure and recurrence in patients with CDI receiving concomitant antibiotics, with a treatment duration of 10 days 3.
- The optimal dose and length of treatment course for fidaxomicin and vancomycin may vary depending on the specific patient population and infection severity.
Recurrence of CDI
- Fidaxomicin has been shown to have a lower rate of recurrence compared to vancomycin in some studies 2, 4, 6.
- However, another study found that fidaxomicin was inferior to metronidazole for recurrent CDI 5.
- The risk of recurrence may depend on various factors, including the antibiotic used, dose, and length of treatment course, as well as patient-specific factors such as underlying health conditions and concomitant antibiotic use.
Patient-Specific Factors
- Patient age, underlying health conditions, and concomitant antibiotic use can affect the efficacy and safety of fidaxomicin and vancomycin for CDI treatment 3, 6.
- Pediatric patients with CDI may have different treatment outcomes compared to adult patients, with fidaxomicin demonstrating higher rates of global cure compared to vancomycin in one study 6.