What is the treatment for Clostridium difficile infection symptoms, such as watery diarrhea, fever, and abdominal pain?

Treatment of Clostridioides difficile Infection Symptoms

Fidaxomicin 200 mg twice daily for 10 days is the preferred first-line treatment for Clostridioides difficile infection (CDI) due to superior sustained clinical response rates and lower recurrence rates. 1

First-Line Treatment Options

Non-Severe Initial CDI

• Fidaxomicin: 200 mg orally twice daily for 10 days 1, 2

  • FDA-approved for adults and pediatric patients aged 6 months and older 2
  • Preferred due to lower recurrence rates
  • Can be taken with or without food 2

• Vancomycin: 125 mg orally four times daily for 10 days 1, 3

  • Alternative first-line option
  • FDA-approved for C. difficile-associated diarrhea 3

• Metronidazole: 500 mg orally three times daily for 10-14 days 1

  • Consider only when fidaxomicin and vancomycin are unavailable
  • Particularly for patients ≤65 years old
  • Not preferred due to higher failure and recurrence rates

Severe CDI

Severe CDI is characterized by hypotension, shock, ileus, or megacolon, with risk factors including:

• Age >60 years
• Fever
• Hypoalbuminemia
• Peripheral leukocytosis
• ICU stay
• Abnormal abdominal CT findings 1

Treatment for severe CDI:

• Vancomycin: 500 mg orally four times daily 1
  • If ileus is present, add rectal instillation of vancomycin
  • Plus intravenous metronidazole 500 mg every 8 hours

Pediatric Treatment

• For children ≥6 months: Fidaxomicin (FDA-approved) 2
• Alternative: Metronidazole 7.5 mg/kg/dose (maximum 500 mg) three or four times daily for 10 days 1
• For children <18 years with C. difficile-associated diarrhea: Vancomycin 40 mg/kg/day in 3-4 divided doses for 7-10 days (not to exceed 2g daily) 3

Treatment of Recurrent CDI

First Recurrence

• Fidaxomicin: 200 mg twice daily for 10 days OR
• Fidaxomicin: 200 mg twice daily for 5 days followed by once every other day for 20 days 1

Second or Subsequent Recurrence

• Consider fecal microbiota transplantation (FMT) after appropriate antibiotic treatments for at least 2 recurrences
• FMT shows 70-90% success rates in preventing further recurrences 1, 4

Monitoring and Follow-up

1. Expect improvement within 2-3 days of starting treatment
2. If no improvement occurs within 48-72 hours:
   • Reassess severity
   • Consider alternative treatments 1
3. Monitor for side effects:
   • Metronidazole: Peripheral neuropathy with prolonged therapy, disulfiram-like reaction with alcohol 1
   • Vancomycin: Nephrotoxicity, especially in patients >65 years 1, 3

Infection Control Measures

• Strict hand hygiene with soap and water (not alcohol-based sanitizers)
• Contact precautions and isolation
• Thorough environmental cleaning
• Discontinue the inciting antibiotic as soon as possible 1

Adjunctive Therapy

• Bezlotoxumab: 10 mg/kg IV once during antibiotic administration may be considered, particularly for immunocompromised patients 1

Important Caveats

1. Oral vancomycin and fidaxomicin are not effective for other types of infections 3, 2
2. Avoid prolonged or repeated courses of metronidazole due to risk of cumulative and potentially irreversible neurotoxicity 1
3. Approximately 20% of patients may experience relapse when treatment is discontinued 5
4. For elderly patients with severe or fulminant CDI who fail standard therapy, FMT should be considered before surgical intervention due to high post-surgical mortality rates approaching 30% in this population 4