From the Guidelines
Vancomycin is the primary alternative antibiotic for treating Clostridioides difficile (C. diff) infection when Dificid (fidaxomicin) cannot be used, with a standard regimen of 125 mg taken orally four times daily for 10-14 days, 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 choice of alternative antibiotic depends on the severity of the infection, recurrence risk, and patient-specific factors such as allergies or comorbidities.
- For initial CDI episodes, vancomycin 125 mg four times daily by mouth for 10 days is an acceptable alternative to fidaxomicin, according to the 2021 IDSA/SHEA guidelines 1.
- For recurrent CDI, vancomycin may be used in a tapered and pulsed regimen, or fidaxomicin may be used, with the goal of reducing the risk of further recurrences 1.
- Metronidazole (500 mg orally three times daily for 10-14 days) is another option, though it's generally considered less effective than vancomycin and is typically reserved for mild cases or when other options aren't available 1.
- Bezlotoxumab, a monoclonal antibody, may be administered as a single intravenous infusion alongside antibiotics to prevent recurrence in high-risk patients, with caution in patients with congestive heart failure 1. These alternatives work by either directly killing the C. diff bacteria (vancomycin and metronidazole) or by neutralizing the toxins produced by C. diff (bezlotoxumab). The 2021 IDSA/SHEA guidelines provide a comprehensive approach to managing CDI, including recommendations for treatment, prevention of recurrence, and use of adjunctive therapies like bezlotoxumab 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Alternative Antibiotics for C. difficile Infection
- Fidaxomicin is a potential alternative to Dificid (fidaxomicin is another name for Dificid) for the treatment of C. difficile infection 2, 3, 4, 5
- Vancomycin is another option for the treatment of C. difficile infection, and it can be used in combination with fidaxomicin or as a standalone treatment 6, 2, 3, 5
- Metronidazole is also mentioned as a treatment option for C. difficile infection, although it may not be as effective as fidaxomicin or vancomycin in preventing recurrence 6, 3
- Other treatment options, such as bezlotoxumab, surotomycin, and rifaximin, are also being developed and tested for the treatment of C. difficile infection 6
- Faecal microbiota transplantation is also a potential treatment option for multiple recurrent C. difficile infection, and it can be used in combination with vancomycin or fidaxomicin 6, 4
Comparison of Treatment Options
- Fidaxomicin has been shown to be superior to vancomycin and metronidazole in preventing recurrence of C. difficile infection in some studies 2, 3
- Vancomycin has been shown to be effective in treating C. difficile infection, but it may not be as effective as fidaxomicin in preventing recurrence 2, 5
- Metronidazole has been shown to be less effective than fidaxomicin and vancomycin in treating C. difficile infection and preventing recurrence 3
Special Considerations
- Patients with inflammatory bowel disease may require special consideration when being treated for C. difficile infection, and fidaxomicin may be a potential treatment option for these patients 4
- Patients receiving concomitant antibiotics for concurrent infections may also require special consideration, and fidaxomicin and vancomycin may be potential treatment options for these patients 5