What is the treatment for Clostridioides difficile infection (CDI) with pseudomembranous colitis?

From the Guidelines

The treatment for Clostridioides difficile infection (CDI) with pseudomembranous colitis typically involves antibiotics targeting C. difficile, with oral vancomycin 125 mg four times daily for 10 days or fidaxomicin 200 mg twice daily for 10 days recommended for initial non-severe episodes, as stated in the 2021 guidelines by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. For severe cases, oral vancomycin 125 mg four times daily for 10 days is preferred. In fulminant cases with hypotension or shock, higher dose vancomycin (500 mg four times daily) plus intravenous metronidazole 500 mg every 8 hours should be used, with surgical consultation for possible colectomy if clinical deterioration occurs, as recommended in the 2018 guidelines by the IDSA and SHEA 1. Bezlotoxumab, a monoclonal antibody against C. difficile toxin B, may be added for patients at high risk of recurrence, as mentioned in the 2021 guidelines by the IDSA and SHEA 1. Fecal microbiota transplantation is highly effective for recurrent CDI after appropriate antibiotic therapy, as recommended in the 2018 guidelines by the IDSA and SHEA 1. Supportive care includes fluid and electrolyte replacement, avoiding antimotility agents, and implementing infection control measures to prevent transmission. Some key points to consider in the treatment of CDI include:

• The use of vancomycin or fidaxomicin as the preferred treatment for initial episodes of CDI, as stated in the 2021 guidelines by the IDSA and SHEA 1
• The consideration of bezlotoxumab for patients at high risk of recurrence, as mentioned in the 2021 guidelines by the IDSA and SHEA 1
• The use of fecal microbiota transplantation for recurrent CDI, as recommended in the 2018 guidelines by the IDSA and SHEA 1
• The importance of supportive care, including fluid and electrolyte replacement, and infection control measures to prevent transmission. It is essential to note that the treatment of CDI should be individualized based on the severity of the disease, the patient's underlying medical conditions, and the risk of recurrence, as stated in the 2021 guidelines by the IDSA and SHEA 1. Additionally, the use of antibiotics should be carefully considered, and the inciting antibiotic should be stopped if possible, as mentioned in the 2018 guidelines by the IDSA and SHEA 1. Overall, the treatment of CDI requires a comprehensive approach that includes antibiotics, supportive care, and infection control measures to prevent transmission and reduce the risk of recurrence, as recommended in the 2021 guidelines by the IDSA and SHEA 1.

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).

The treatment for Clostridioides difficile infection (CDI) with pseudomembranous colitis is fidaxomicin (PO), as indicated in the drug label 2.

• Key points:
  • Fidaxomicin is used to treat C. difficile-associated diarrhea (CDAD).
  • It is indicated in adult and pediatric patients aged 6 months and older.
  • The drug label does not provide specific information on the treatment of pseudomembranous colitis, but it is a complication of CDI.
• Clinical decision: Fidaxomicin can be used to treat CDI, which may include pseudomembranous colitis, in patients aged 6 months and older.

From the Research

Treatment for Clostridioides difficile Infection (CDI) with Pseudomembranous Colitis

The treatment for CDI with pseudomembranous colitis typically involves the use of antibiotics. The following are some of the key points to consider:

• Fidaxomicin and vancomycin are two commonly used antibiotics for the treatment of CDI 3, 4.
• Fidaxomicin has been shown to be non-inferior to vancomycin in terms of clinical cure rates, and it may have a lower rate of recurrence 3, 4.
• Vancomycin is often used at a dose of 125 mg four times daily, although some studies have used higher doses 5, 6.
• The optimal dose of vancomycin is not well established, but low-dose vancomycin (125 mg) has been shown to be equivalent to high-dose vancomycin (250 mg or 500 mg) in terms of clinical outcomes 6.
• Prolonged oral vancomycin may be effective in preventing relapse in patients with frequently relapsing CDI 7.

Antibiotic Regimens

Some of the antibiotic regimens that have been studied for the treatment of CDI include:

• Fidaxomicin 200 mg twice daily for 10 days 3
• Vancomycin 125 mg four times daily for 10 days 5
• Vancomycin 125 mg once daily for prolonged periods (e.g. 8 weeks) for secondary prophylaxis of relapsing CDI 7
• Vancomycin 250 mg or 500 mg four times daily for 10 days 6

Key Considerations

Some key considerations in the treatment of CDI with pseudomembranous colitis include:

• The choice of antibiotic regimen should be based on the severity of the disease, the presence of complications, and the patient's underlying medical conditions.
• The duration of treatment should be individualized based on the patient's response to therapy.
• Recurrence is a common problem in CDI, and strategies to prevent recurrence, such as prolonged oral vancomycin, may be necessary in some cases 7.