From the Guidelines
The treatment of Clostridioides difficile (C. diff) infection should be guided by the severity of the disease, with fidaxomicin 200 mg given 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
The following treatment options are recommended based on the clinical presentation of the patient:
- For initial CDI episodes, fidaxomicin 200 mg given twice daily for 10 days is the preferred treatment, with vancomycin 125 mg given 4 times daily by mouth for 10 days being an acceptable alternative 1.
- For first CDI recurrence, fidaxomicin 200 mg given twice daily for 10 days, or twice daily for 5 days followed by once every other day for 20 days, is the preferred treatment, with vancomycin by mouth in a tapered and pulsed regimen being an alternative option 1.
- For second or subsequent CDI recurrences, fidaxomicin 200 mg given twice daily for 10 days, or twice daily for 5 days followed by once every other day for 20 days, is recommended, with vancomycin by mouth in a tapered and pulsed regimen, or vancomycin 125 mg 4 times daily by mouth for 10 days followed by rifaximin 400 mg 3 times daily for 20 days, being alternative options 1.
- For fulminant CDI, vancomycin 500 mg 4 times daily by mouth or by nasogastric tube, with or without rectal instillation of vancomycin, and intravenously administered metronidazole 500 mg every 8 hours, is recommended 1.
Supportive Care
Supportive care measures, such as fluid replacement, avoiding antimotility agents, and discontinuing the inciting antibiotic if possible, are essential in managing CDI 1.
Prevention of Transmission
Hand hygiene and contact precautions are crucial in preventing the transmission of C. diff, as the spores can survive on surfaces for months 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 (DIFICID), which is indicated for adult and pediatric patients aged 6 months and older.
- The recommended dosage for adults is one 200 mg DIFICID tablet orally twice daily for 10 days.
- The recommended dosage for pediatric patients is based on weight, with dosages ranging from 80 mg to 200 mg administered orally twice daily for 10 days 2.
From the Research
Treatment Options for Clostridioides difficile (C. diff) Infection
- Vancomycin and metronidazole were historically considered equivalent therapies for the management of Clostridium difficile infections (CDI) 3
- Fidaxomicin is a narrow spectrum antibiotic that has an advantage in reducing recurrence rates compared with vancomycin, possibly owing to its sparing effect on normal colonic microbiota 3
- The use of fidaxomicin is recommended as first-line therapy for all patients with Clostridioides difficile infection (CDI) 4
Comparison of Fidaxomicin and Vancomycin
- Fidaxomicin was associated with a 63% reduction in the risk of the composite outcome of clinical failure, 30-day relapse, or CDI-related death compared to vancomycin 4
- A systematic review and meta-analysis found that fidaxomicin was consistently associated with a lower risk of CDI recurrence than vancomycin, with a 31% reduction in the risk of recurrence 5
- Fidaxomicin was non-inferior to vancomycin for treatment of CDI and had a significant reduction in recurrences 6
Clinical Guidance for Fidaxomicin Use
- Fidaxomicin has been proven to be superior to vancomycin in successful sustained clinical response to therapy, particularly in groups at high risk for CDI recurrence 7
- The drug should be targeted to those populations who are at high risk for relapse and in whom the drug has demonstrated superiority, due to its high cost compared to other treatment regimens 6, 7