From the Guidelines
The best treatment for Clostridioides difficile (C. diff) infection is fidaxomicin 200 mg given twice daily for 10 days, as it has been shown to have lower recurrence rates compared to vancomycin, according to the most recent guidelines from the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) 1. For initial mild to moderate cases, fidaxomicin is the preferred treatment, while vancomycin 125 mg given four times daily for 10 days is an acceptable alternative. Some key points to consider in the treatment of C. diff infection include:
- For severe infections, vancomycin 125 mg four times daily for 10 days is recommended, while for fulminant cases, vancomycin 500 mg four times daily orally plus intravenous metronidazole 500 mg every 8 hours is indicated.
- Metronidazole 500 mg three times daily for 10 days is now considered a second-line agent due to increasing treatment failures.
- For recurrent infections, extended vancomycin tapers or fidaxomicin may be used, and fecal microbiota transplantation has shown excellent success rates (>85%) for multiple recurrences by restoring normal gut flora.
- Supportive care includes discontinuing the inciting antibiotic if possible, avoiding antimotility agents which can worsen symptoms, and implementing strict contact precautions to prevent transmission.
- Treatment should begin promptly upon diagnosis as C. diff can rapidly progress to life-threatening complications including toxic megacolon and sepsis, as noted in the guidelines from the IDSA and SHEA 1, as well as other studies 1.
From the FDA Drug Label
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. DIFICID® is indicated in adult and pediatric patients aged 6 months and older for the treatment of C. difficile-associated diarrhea (CDAD).
The best treatment for Clostridioides difficile (C diff) infection is fidaxomicin (PO), as it is indicated for the treatment of C. difficile-associated diarrhea (CDAD) in adult and pediatric patients aged 6 months and older 2.
- Key points:
- Fidaxomicin is used to treat CDAD.
- It is effective in adult and pediatric patients aged 6 months and older.
- Bezlotoxumab (IV) is not used to treat C-diff, but to help decrease the risk of C-diff from coming back in adults and children 1 year of age and older who are taking an antibiotic for C-diff and who have a high risk of C-diff coming back 3.
From the Research
Treatment Options for C diff Infection
The treatment for Clostridioides difficile (C diff) infection typically involves antibiotics such as vancomycin, metronidazole, or fidaxomicin 4, 5. However, for recurrent C diff infections, fecal microbiota transplantation (FMT) has emerged as a promising therapeutic option 4, 6, 7, 8.
Efficacy of Fecal Microbiota Transplantation
Studies have shown that FMT can be highly effective in treating recurrent C diff infections, with success rates of over 85% compared to less than 50% with antibiotics for multiple recurrent C diff infections 6. A randomized, double-blind, placebo-controlled trial found that FMT was superior to the standard of care vancomycin alone in achieving sustained resolution from C diff, with a resolution rate of 90% in the FMT group compared to 33% in the placebo group 8.
Safety of Fecal Microbiota Transplantation
While FMT has been shown to be effective, there are also potential risks and adverse events associated with the treatment, including transmission of pathobionts and severe acute respiratory syndrome coronavirus-2 6. However, studies have also reported mild and self-limited adverse effects, with a low rate of serious adverse events 7, 8.
Comparison of Treatment Options
A study comparing the efficacy and safety of FMT to placebo after vancomycin for first or second C diff infection found that FMT was highly effective and superior to the standard of care vancomycin alone in achieving sustained resolution from C diff 8. Another study found that FMT had a high efficacy as a rescue treatment in cases with refractory or recurrent C diff, regardless of severity, with mild side effects 7.
Key Findings
- FMT is a promising therapeutic option for recurrent C diff infections 4, 6, 7, 8
- FMT has been shown to be highly effective in treating recurrent C diff infections, with success rates of over 85% 6
- FMT is superior to the standard of care vancomycin alone in achieving sustained resolution from C diff 8
- FMT has potential risks and adverse events, including transmission of pathobionts and severe acute respiratory syndrome coronavirus-2 6
- FMT has been reported to have mild and self-limited adverse effects, with a low rate of serious adverse events 7, 8