From the Guidelines
The recommended treatment for Clostridioides difficile infection is fidaxomicin 200 mg given twice daily for 10 days for an initial episode, and for recurrent episodes, fidaxomicin 200 mg given twice daily for 10 days or vancomycin in a tapered and pulsed regimen. The treatment approach depends on the severity of the infection and whether it's an initial or recurrent episode. For mild to moderate first infections, oral vancomycin 125 mg four times daily for 10 days or fidaxomicin 200 mg twice daily for 10 days is recommended 1. For severe infections, the same regimens are used, but hospitalization may be necessary. For fulminant C. diff with hypotension or shock, vancomycin 500 mg four times daily (orally or via nasogastric tube) plus intravenous metronidazole 500 mg every 8 hours is recommended, with surgical consultation for possible colectomy if clinical deterioration occurs 1.
Key Considerations
- For first recurrences, using a different antibiotic than the initial treatment is advised, with options including fidaxomicin or vancomycin in a tapered and pulsed regimen 1.
- For multiple recurrences, options include vancomycin in a tapered and pulsed regimen, fidaxomicin extended regimen, or fecal microbiota transplantation 1.
- Metronidazole (500 mg three times daily for 10 days) is now considered a second-line agent due to increasing resistance 1.
- Supportive care includes fluid replacement, avoiding antimotility agents, and discontinuing the inciting antibiotic if possible 1.
Treatment Options
- Fidaxomicin: 200 mg twice daily for 10 days for initial episodes, and for recurrent episodes, 200 mg twice daily for 10 days or vancomycin in a tapered and pulsed regimen 1.
- Vancomycin: 125 mg four times daily for 10 days for initial episodes, and for recurrent episodes, vancomycin in a tapered and pulsed regimen 1.
- Fecal microbiota transplantation: for patients with multiple recurrences who have failed antibiotic treatments 1.
Important Considerations for Fecal Microbiota Transplantation
- Patient selection: appropriate antibiotic treatments for at least 2 recurrences (ie, 3 CDI episodes) should be tried before considering FMT 1.
- Donor selection: careful evaluation and screening of stool donors to minimize the risk of transmissible infections 1.
- Route of instillation: options include colonoscopy, nasogastric tube, or enema, with varying success rates 1.
From the FDA Drug Label
Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea. The recommended dose is 125 mg administered orally 4 times daily for 10 days. DIFICID is a macrolide antibacterial indicated in adult and pediatric patients 6 months of age and older for the treatment of C. difficile-associated diarrhea. Adults: One 200 mg tablet orally twice daily for 10 days.
The recommended treatments for C. difficile infection are:
- Vancomycin: 125 mg orally 4 times daily for 10 days 2
- Fidaxomicin: 200 mg orally twice daily for 10 days 3
From the Research
Treatment Options for C diff Infection
The recommended treatment for Clostridioides difficile (C diff) infection includes:
- Oral vancomycin alone for severe CDI 4
- Fidaxomicin as an alternative, especially in patients at risk of relapse 5, 6
- Surotomycin, a novel antibiotic, which has been shown to be non-inferior to vancomycin 7
- Metronidazole, although its efficacy has been decreasing overall 5
Recurrent C diff Infection
For recurrent CDI, treatment options include:
- Vancomycin combined with faecal microbiota transplantation 8, 6
- Fidaxomicin and rifaximin as alternative antibacterial treatments 8
- Probiotics, such as Saccharomyces boulardii, may be considered 8
- Monoclonal antibodies and faecal transplantation are also promising therapies 8
Comparison of Treatment Outcomes
Studies have compared treatment outcomes between monotherapy and combination therapy for severe CDI: