From the Guidelines
The treatment for Clostridioides difficile (C. diff) infection primarily involves antibiotics targeted specifically against this bacterium, with fidaxomicin 200 mg twice daily for 10 days being the preferred treatment for initial episodes, 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.
Treatment Options
- For mild to moderate first episodes, oral vancomycin 125 mg four times daily for 10 days is an alternative treatment option 1.
- For severe infections, oral vancomycin 125 mg four times daily for 10 days is the preferred treatment, while for fulminant cases with complications like hypotension or shock, higher doses of vancomycin (500 mg four times daily) may be used, often combined with intravenous metronidazole 500 mg every 8 hours 1.
- For recurrent infections, extended vancomycin regimens with tapering doses, fidaxomicin, or fecal microbiota transplantation may be necessary, with the AGA suggesting select use of fecal microbiota-based therapies on completion of standard of care antibiotics to prevent recurrence in immunocompetent adults with recurrent C difficile infection 1.
Supportive Care
- Supportive care includes fluid and electrolyte replacement, avoiding antimotility agents which can worsen symptoms, and discontinuing the inciting antibiotic if possible.
- Infection control measures like proper hand hygiene and contact precautions are essential to prevent transmission to others.
Special Considerations
- Bezlotoxumab, a human monoclonal antibody, may be used as adjunctive treatment to prevent recurrences of CDI, particularly in patients with CDI due to the 027 epidemic strain, in immunocompromised patients, and in patients with severe CDI 1.
- Fecal microbiota transplantation is an effective option for patients with multiple CDI recurrences who have failed appropriate antibiotic treatments, but its use should be selective and based on individual patient risk factors and disease severity 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 (C. diff) infection is fidaxomicin (PO), as indicated in the drug label for adult and pediatric patients aged 6 months and older 2.
- Key points:
- Fidaxomicin is used to treat C. difficile-associated diarrhea (CDAD).
- It should be used only to treat infections that are proven or strongly suspected to be caused by C. difficile.
From the Research
Treatment Options for C. diff Infection
- The primary treatment for Clostridium difficile (C. diff) infection includes oral vancomycin, which is proposed to become the first choice when antibiotic treatment for C. diff is necessary 3.
- Fidaxomicin is a good alternative, especially in patients at risk of relapse, as it has been shown to have a lower rate of recurrence compared to vancomycin 4.
- Metronidazole is mentioned as a first-line therapy, but its efficacy has been found to be lower than vancomycin, especially in severe cases 3, 5.
Recurrent C. diff Infection
- Recurrent C. diff infection poses a significant challenge, with a high recurrence rate of up to 20% 3.
- Vancomycin combined with fecal microbiota transplantation (FMT) remains the primary therapy for multiple recurrent C. diff infection 3.
- FMT has also been shown to be effective in treating recurrent C. diff infection in pediatric patients, including those with cystic fibrosis 6.
Alternative Therapies
- Other promising therapies for C. diff infection include the use of monoclonal antibodies, probiotics (e.g., Saccharomyces boulardii), and combination therapy with vancomycin 7.
- New medications that protect the gut microbiota are being developed and tested to prevent C. diff infection during antibiotic therapy 3.
- Fidaxomicin has been found to be noninferior to vancomycin in terms of clinical cure rates and has a significantly lower rate of recurrence 4.