From the Guidelines
The treatment for Clostridioides difficile (C. difficile) infection is primarily based on the severity of the infection, with fidaxomicin and vancomycin being the preferred treatments for initial and recurrent episodes, respectively, as recommended by the 2021 focused update guidelines by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. The choice of treatment depends on the clinical presentation of the patient, with considerations for the severity of the infection, potential for recurrence, and the presence of any underlying conditions that may affect treatment outcomes.
- For an initial episode of C. difficile infection, fidaxomicin 200 mg given twice daily for 10 days is the preferred treatment, with vancomycin 125 mg given four times daily by mouth for 10 days being an acceptable alternative 1.
- In cases of recurrent C. difficile infection, fidaxomicin 200 mg given twice daily for 10 days or vancomycin by mouth in a tapered and pulsed regimen are recommended, with consideration for adjunctive treatment with bezlotoxumab 10 mg/kg given intravenously once during administration of standard of care antibiotics 1.
- For fulminant C. difficile infection, vancomycin 500 mg four times daily by mouth or by nasogastric tube, with or without rectal instillation, and intravenously administered metronidazole are recommended 1. It is essential to note that the treatment guidelines may vary depending on the specific clinical scenario and the presence of any underlying conditions, such as immunocompromised status or congestive heart failure, which may affect treatment outcomes and the risk of recurrence 1. During treatment, patients should stay well-hydrated, avoid anti-diarrheal medications, and practice strict hand hygiene to prevent spreading the infection. For recurrent infections, extended vancomycin regimens, fecal microbiota transplantation, or bezlotoxumab may be considered, with the choice of treatment depending on the individual patient's clinical presentation and treatment history 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).
1 INDICATIONS AND USAGE
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. (1.1)
The treatment for Clostridioides difficile (C. difficile) infection is fidaxomicin (PO), which is indicated in adult and pediatric patients 6 months of age and older for the treatment of C. difficile-associated diarrhea (CDAD) 2, 2, 2.
- Key points:
- Fidaxomicin is a macrolide antibacterial.
- It should be used only to treat infections that are proven or strongly suspected to be caused by C. difficile.
- The treatment is indicated in adult and pediatric patients 6 months of age and older.
From the Research
Treatment Options for Clostridioides difficile Infection
The treatment for Clostridioides difficile (C. difficile) infection typically involves the use of antibiotics such as vancomycin, metronidazole, or fidaxomicin 3. However, for recurrent C. difficile infections, fecal microbiota transplantation (FMT) has emerged as a promising therapeutic option 4, 5, 6, 7.
Fecal Microbiota Transplantation (FMT)
FMT has been shown to be effective in restoring the gut microbiota and promoting the recovery of colonization resistance in patients with recurrent C. difficile infections 4, 5, 6, 7. Studies have demonstrated that FMT can lead to higher success rates compared to vancomycin, fidaxomicin, or placebo in treating recurrent C. difficile infections 6, 7.
Key Points
- Vancomycin is the preferred treatment for C. difficile infection, but has a high recurrence rate 4, 3
- FMT is a promising therapeutic option for recurrent C. difficile infections 4, 5, 6, 7
- FMT can restore the gut microbiota and promote the recovery of colonization resistance 4, 5, 6, 7
- Standardized microbiome-based therapies, such as SER-109 and RBX2660, are also available for the treatment of recurrent C. difficile infections 6
Comparison of Treatment Options
Studies have compared the effectiveness of FMT with other treatment options, such as fidaxomicin and vancomycin 7. The results have shown that FMT is superior to fidaxomicin and vancomycin in achieving clinical and microbiological resolution in patients with recurrent C. difficile infections 7.
Recurrent C. difficile Infection Treatment
For patients with recurrent C. difficile infections, the treatment options include: