From the Guidelines
The recommended antibiotic treatment for Clostridioides difficile (C. diff) infection is fidaxomicin 200 mg given twice daily for 10 days, as it has been shown to be effective in treating initial and recurrent episodes of CDI, with a lower risk of recurrence compared to vancomycin 1.
Key Considerations
- For initial CDI episodes, fidaxomicin is suggested over vancomycin due to its beneficial effects and safety, although vancomycin remains an acceptable alternative 1.
- In patients with recurrent CDI episodes, fidaxomicin (standard or extended-pulsed regimen) is recommended over a standard course of vancomycin, with vancomycin in a tapered and pulsed regimen or vancomycin as a standard course being acceptable alternatives 1.
- Metronidazole 500 mg three times daily for 10 days may be used as a second-line option for non-severe CDI, but its use is limited due to lower cure rates and potential side effects 1.
Treatment Options
- Fidaxomicin: 200 mg twice daily for 10 days
- Vancomycin: 125 mg four times daily for 10 days (or 500 mg four times daily for severe infections)
- Metronidazole: 500 mg three times daily for 10 days (second-line option for non-severe CDI)
Special Considerations
- Fulminant CDI with complications like shock or ileus: intravenous metronidazole 500 mg every 8 hours should be added to oral or rectal vancomycin 1.
- Recurrent infections: extended vancomycin tapers, fidaxomicin, or bezlotoxumab (a monoclonal antibody) may be used 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.
The recommended antibiotic treatment for Clostridioides difficile (C. diff) infection is vancomycin, with a dose of 125 mg orally 4 times daily for 10 days 2.
- Key points:
- Vancomycin is effective for the treatment of C. difficile-associated diarrhea.
- The recommended dose is 125 mg administered orally 4 times daily for 10 days.
- Vancomycin Hydrochloride Capsules are contraindicated in patients with known hypersensitivity to vancomycin.
Alternatively, fidaxomicin is also an option, with a dose of 200 mg orally twice daily for 10 days 3.
- Key points:
- Fidaxomicin is a macrolide antibacterial drug that inhibits RNA synthesis by binding to RNA polymerases.
- Fidaxomicin is bactericidal against C. difficile in vitro.
- The recommended dose is 200 mg orally twice daily for 10 days.
From the Research
Recommended Antibiotic Treatment for C. diff Infection
The recommended antibiotic treatment for Clostridioides difficile (C. diff) infection includes:
- Fidaxomicin: a first-in-class, oral macrocyclic antibiotic with targeted bactericidal activity against C. difficile, which has been shown to be superior to vancomycin in preventing disease recurrence 4, 5, 6
- Vancomycin: an oral antibiotic that is effective in treating C. diff infection, but may have a higher risk of recurrence compared to fidaxomicin 4, 7, 8
- Metronidazole: an oral antibiotic that is less effective than fidaxomicin and vancomycin in treating C. diff infection, and may have a higher risk of recurrence 4, 5, 6
Treatment Outcomes
Studies have shown that:
- Fidaxomicin is superior to vancomycin and metronidazole in preventing disease recurrence and achieving sustained clinical cure 4, 5, 6
- Vancomycin is effective in treating C. diff infection, but may have a higher risk of recurrence compared to fidaxomicin 4, 7, 8
- Metronidazole is less effective than fidaxomicin and vancomycin in treating C. diff infection, and may have a higher risk of recurrence 4, 5, 6
- The use of oral vancomycin does not increase the risk of vancomycin-resistant Enterococci (VRE) compared to metronidazole 8
Dosage and Administration
The optimal dosage and administration of antibiotics for C. diff infection are:
- Fidaxomicin: 200 mg twice daily for 7-10 days 4, 6
- Vancomycin: 125 mg four times daily for 7-10 days, with no significant difference in recurrence rates between low-dose (<2 g per day) and high-dose (2 g per day) regimens 7
- Metronidazole: 9.3 mg three times daily for 7-10 days, although this regimen is less effective than fidaxomicin and vancomycin 4, 5, 6