What is the treatment for Clostridium difficile?

From the Guidelines

The treatment for Clostridium difficile infection should prioritize fidaxomicin 200 mg twice daily for 10 days as the first-line treatment for initial episodes, given its superiority in reducing recurrences compared to vancomycin, as recommended by the most recent guidelines 1. When considering the treatment options for Clostridium difficile infection, it's crucial to differentiate between the severity of the infection and the number of recurrences.

• For initial episodes of non-severe Clostridium difficile infection, fidaxomicin 200 mg twice daily for 10 days is recommended as the first-line treatment due to its efficacy in reducing recurrence rates compared to vancomycin 1.
• For severe infections, oral vancomycin at a dose of 125 mg four times daily for 10 days is still considered a viable option, although fidaxomicin may be preferred due to its reduced recurrence rates.
• In cases of fulminant C. difficile infection with complications like ileus, the treatment should involve vancomycin 500 mg four times daily by mouth or by nasogastric tube, potentially combined with intravenous metronidazole (500 mg every 8 hours) 1.
• Metronidazole alone is now considered a second-line agent due to increasing resistance and higher recurrence rates, and its use should be limited to situations where first-line treatments are not available or appropriate.
• For recurrent infections, extended vancomycin tapers, fidaxomicin, or fecal microbiota transplantation may be considered, with the choice depending on the number of recurrences and the patient's specific clinical scenario 1. It's also important to note that during treatment, discontinuing the inciting antibiotic if possible, avoiding antimotility agents, and implementing infection control measures are crucial to prevent the spread of C. difficile and support the recovery of the gut microbiome. The most recent guidelines from 2021 1 provide the basis for these recommendations, emphasizing the importance of tailored treatment approaches based on the severity and recurrence of Clostridium difficile infection.

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 Clostridium difficile is fidaxomicin (DIFICID), which is indicated for the treatment of C. difficile-associated diarrhea (CDAD) in adult and pediatric patients aged 6 months and older 2.

• The medication should be taken exactly as directed
• Twice a day (approximately every 12 hours)
• Can be taken with or without food It is essential to complete the full course of therapy to decrease the effectiveness of the immediate treatment and increase the likelihood that bacteria will develop resistance and will not be treatable by DIFICID or other antibacterial drugs in the future 2.

From the Research

Treatment Options for Clostridium difficile

The treatment for Clostridium difficile (C. difficile) typically involves antibiotics, but for recurrent or severe cases, other options such as fecal microbiota transplantation (FMT) have shown promise.

• Fecal microbiota transplantation (FMT) has been studied as a treatment for recurrent C. difficile infection (rCDI) and has been found to be effective in resolving the infection 3, 4, 5, 6, 7.
• A study published in 2017 found that sequential FMT for inpatients with severe or severe-complicated CDI is promising and may be preferred over colectomy in certain patients 3.
• A 2023 systematic review found that FMT likely leads to a large increase in resolution of rCDI in immunocompetent participants compared to alternative treatments such as antibiotics 4.
• Another study published in 2019 found that FMT is superior to fidaxomicin for treatment of recurrent C. difficile infection 5.
• A randomized clinical trial published in 2015 found that FMT via colonoscopy was significantly more effective than vancomycin regimen for the treatment of recurrent C. difficile infection 6.
• FMT has been reported to be safe, inexpensive, and effective, with a cure rate of about 90% according to case and small series reports 7.

Administration and Efficacy

• FMT can be administered via colonoscopy, nasoduodenal tube, or enema 4, 5, 6.
• The efficacy of FMT has been found to be high, with resolution of C. difficile-associated diarrhea reported in 71-92% of patients 4, 5, 6.
• FMT has also been found to be effective in reducing serious adverse events and all-cause mortality, although the evidence is not conclusive due to the small number of events 4.