What is the treatment for Clostridioides difficile (C. diff) infection caused by Augmentin (amoxicillin-clavulanate)?

From the Guidelines

The treatment for Clostridioides difficile (C. diff) infection caused by Augmentin (amoxicillin-clavulanate) should start with discontinuing the offending antibiotic if possible, and then initiating fidaxomicin 200 mg twice daily for 10 days as the preferred treatment for an initial episode, according to the most recent guidelines 1.

Key Considerations

• The choice of treatment depends on the severity of the infection and whether it is an initial episode or a recurrence.
• For initial episodes, fidaxomicin is preferred due to its efficacy in reducing recurrences compared to vancomycin 1.
• Vancomycin 125 mg four times daily for 10 days is an alternative for initial episodes, especially if fidaxomicin is not available 1.
• For recurrent infections, options include fidaxomicin, vancomycin in a tapered and pulsed regimen, or vancomycin followed by rifaximin 1.
• Supportive care, including fluid and electrolyte replacement, is crucial in managing C. diff infections.

Treatment Options

• Fidaxomicin 200 mg twice daily for 10 days for initial episodes, given its superior sustained clinical response rates 1.
• Vancomycin 125 mg four times daily for 10 days as an alternative for initial episodes or for recurrent infections, with consideration for a tapered and pulsed regimen in recurrent cases 1.
• Metronidazole 500 mg three times daily for 10-14 days may be considered for non-severe initial episodes if fidaxomicin and vancomycin are not available, but it is less preferred due to lower efficacy in preventing recurrences 1.

Special Considerations

• In cases of severe, complicated C. diff infection, higher doses of oral vancomycin (500 mg four times daily) may be used, sometimes with intravenous metronidazole 500 mg every 8 hours 1.
• Fecal microbiota transplantation may be considered for multiple recurrences, particularly after other treatments have failed, with careful selection of patients and donors 1.
• The treatment approach should be individualized based on the patient's clinical presentation, history of prior CDI, and response to previous treatments, as well as considerations for potential antibiotic resistance and side effects.

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.

The treatment for Clostridioides difficile (C. diff) infection caused by Augmentin (amoxicillin-clavulanate) is fidaxomicin (DIFICID).

• 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, as shown in Table 1, and is administered orally twice daily for 10 days 2.

From the Research

Treatment for C. diff Infection Caused by Augmentin

The treatment for Clostridioides difficile (C. diff) infection, which can be caused by the use of antibiotics such as Augmentin (amoxicillin-clavulanate), depends on the severity of the infection and whether it is an initial or recurrent episode.

• For an initial episode of non-severe C. diff infection, oral vancomycin or oral fidaxomicin is recommended 3, 4, 5.
• Metronidazole is no longer recommended as first-line therapy for adults due to its lower efficacy compared to vancomycin and fidaxomicin 3, 5, 6.
• Fecal 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, 5, 7.
• Bezlotoxumab infusion, 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 3, 4.

Risk Factors and Prevention

• Risk factors for C. diff infection include recent exposure to healthcare facilities, antibiotic therapy (especially clindamycin and broad-spectrum antibiotics like Augmentin), old age, and hospital or nursing home stay 5, 7.
• Good antibiotic stewardship is a key strategy to decrease rates of C. diff infection 5.
• Hand hygiene with soap and water or an alcohol-based product is crucial in preventing the spread of C. diff, especially in healthcare settings 5.