From the Guidelines
Fidaxomicin 200 mg given twice daily for 10 days is the preferred treatment for an initial Clostridioides difficile infection (CDI) episode, 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. The treatment approach for CDI varies depending on the clinical presentation and severity of the infection.
- For an initial CDI episode, the alternative treatment options include Vancomycin 125 mg given 4 times daily by mouth for 10 days, or Metronidazole 500 mg 3 times daily by mouth for 10–14 days for nonsevere CDI 1.
- In cases of CDI recurrence, the preferred treatment options include Fidaxomicin 200 mg given twice daily for 10 days, or Vancomycin by mouth in a tapered and pulsed regimen 1.
- For fulminant CDI, Vancomycin 500 mg 4 times daily by mouth or by nasogastric tube is recommended, with the addition of rectal instillation of Vancomycin if ileus is present, and intravenously administered Metronidazole 500 mg every 8 hours 1. The choice of treatment should be guided by the severity of the infection, the presence of recurrence, and the patient's overall clinical condition, with the goal of minimizing morbidity, mortality, and improving quality of life.
- Bezlotoxumab 10 mg/kg given intravenously once during administration of standard of care antibiotics may be considered as an adjunctive treatment for patients with CDI recurrence, particularly those with risk factors such as age >65 years, immunocompromised host, or severe CDI on presentation 1.
- Fecal microbiota transplantation may be considered for patients with multiple recurrences of CDI, after appropriate antibiotic treatments have been tried 1.
From the FDA Drug Label
DIFICID® is indicated in adult and pediatric patients aged 6 months and older for the treatment of C. difficile-associated diarrhea (CDAD). To reduce the development of drug-resistant bacteria and maintain the effectiveness of DIFICID and other antibacterial drugs, DIFICID should be used only to treat infections that are proven or strongly suspected to be caused by C. difficile.
Fidaxomicin is used to treat C. difficile-associated diarrhea (CDAD) in adults and pediatric patients aged 6 months and older 2.
- The recommended dosage for adults is one 200 mg DIFICID tablet orally twice daily for 10 days.
- For pediatric patients, the dosage is based on weight, with tablets or oral suspension administered orally twice daily for 10 days. The treatment should only be used to treat infections that are proven or strongly suspected to be caused by C. difficile 3.
From the Research
Treatment Options for C. difficile Infection
- Vancomycin is a commonly used treatment for C. difficile infection, as seen in studies 4, 5, 6, 7, 8
- Fidaxomicin is also used to treat C. difficile infection and has been shown to be noninferior to vancomycin in terms of clinical cure rates 4, 5, 6, 7, 8
- Metronidazole is no longer recommended as first-line therapy for adults with C. difficile infection, except in mild-to-moderate cases with no risk factors for recurrence 5, 6
- Bezlotoxumab, a monoclonal antibody against C. difficile toxin B, may be considered as an adjunctive therapeutic strategy in patients with recurrent C. difficile infection and multiple risk factors for recurrence 5
- Faecal microbiota transplantation (FMT) is a reasonable treatment option for patients with multiple recurrent episodes of C. difficile infection who have received appropriate antibiotic therapy 5, 6
Comparison of Fidaxomicin and Vancomycin
- Fidaxomicin has been shown to be associated with a lower rate of recurrence of C. difficile infection compared to vancomycin in some studies 4, 7
- However, other studies have found similar rates of clinical cure and recurrence between fidaxomicin and vancomycin 8
- The choice between fidaxomicin and vancomycin may depend on individual patient factors, such as the presence of risk factors for recurrence or the severity of the infection 5, 6