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 supported by the 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1.
Treatment Approach
The approach to treating C. diff infection depends on the severity of the disease. Mild cases may resolve by stopping the offending antibiotic, while more severe cases require specific antibiotic treatment.
- For initial episodes, oral vancomycin or fidaxomicin is the preferred treatment.
- For severe or recurrent infections, extended vancomycin regimens or fidaxomicin may be necessary.
- Fecal microbiota transplantation (FMT) is an effective treatment for multiple recurrences, with a high success rate, especially when administered via the colon 1.
Prevention Strategies
Prevention of C. diff infection includes:
- Proper hand hygiene with soap and water, as alcohol-based sanitizers are ineffective against C. diff spores.
- Contact precautions for infected patients.
- Antimicrobial stewardship to limit unnecessary antibiotic use.
Disease Severity and Recurrence
C. diff infection can range from mild diarrhea to life-threatening colitis. The severity of the disease and the risk of recurrence are critical factors in determining the treatment approach.
- Severe CDI is defined by signs of severe colitis, significant systemic toxin effects, and shock, which may require ICU admission, colectomy, or can result in death 1.
- Recurrent CDI is a significant concern, with the risk of recurrence increasing with each successive episode, and is associated with a higher risk of mortality 1.
Fecal Microbiota Transplantation (FMT)
FMT has emerged as a viable treatment option for recurrent C. diff infection, with studies showing high efficacy rates, especially when administered via the colon 1.
- The procedure involves the instillation of processed stool from a healthy donor into the intestinal tract of the patient.
- FMT has been shown to restore the normal microbiota diversity and reduce the risk of recurrence.
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 2.
- 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 (CDI), is a significant global health problem, causing life-threatening diarrhea and refractory recurrence in patients 3.
- CDI is generally associated with changes in the normal intestinal microbiota caused by administration of antibiotics, and elderly and immunocompromised patients are at greater risk for CDI and CDI recurrence 4.
Treatment Options
- Current recommendations for treating CDI include vancomycin and fidaxomicin as first-line drugs, with metronidazole only recommended for mild-to-moderate disease in younger patients with no or few risk factors for recurrence 4.
- Bezlotoxumab, a monoclonal antibody against C. difficile toxin B, may be considered as an adjunctive therapeutic strategy in addition to standard care for patients with several risk factors for recurrence 4, 5.
- Faecal microbiota transplantation (FMT) is a reasonable treatment option with high cure rates in patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes 4, 6, 7.
Prevention of Recurrent CDI
- Several interventions have been shown to be effective in preventing recurrent CDI, including fidaxomicin, FMT, and monoclonal antibodies such as bezlotoxumab 6, 5.
- Prebiotics, probiotics, and non-antibiotic polymers, such as oligofructose and Saccharomyces boulardii, have also been shown to be efficacious in preventing recurrent CDI 6.
- Good antibiotic stewardship is a key strategy to decrease rates of C. difficile infection, and hands should be cleaned with either soap and water or an alcohol-based product to prevent transmission 7.