What is the treatment for Clostridiium difficile (C. diff) infection?

From the Guidelines

The treatment for Clostridioides difficile (C. diff) infection depends on severity, but typically involves antibiotics, with fidaxomicin 200 mg given twice daily for 10 days being the preferred treatment for initial episodes, as recommended by the 2021 guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1.

Treatment Options

• For mild to moderate cases, oral vancomycin (125 mg four times daily for 10 days) is an alternative option, as it remains an acceptable alternative to fidaxomicin 1.
• For severe cases, oral vancomycin at the same dose is preferred, while in fulminant cases with complications, higher-dose vancomycin (500 mg four times daily) may be used, sometimes with intravenous metronidazole (500 mg every 8 hours) 1.
• Metronidazole alone (500 mg three times daily for 10 days) is now considered a second-line option due to increasing resistance.

Recurrent Infections

• For recurrent infections, extended vancomycin tapers or fidaxomicin may be used, with fidaxomicin 200 mg given twice daily for 10 days being the preferred treatment for first recurrences 1.
• Fecal microbiota transplantation is highly effective for multiple recurrences, but should only be considered after at least two recurrences have been treated with appropriate antibiotic therapy 1.

Supportive Care

• Supportive care includes stopping the inciting antibiotic if possible, maintaining hydration, avoiding antimotility agents, and implementing contact precautions to prevent spread.
• C. diff causes disease by disrupting normal gut flora, allowing toxin production that damages the intestinal lining, which explains why restoring normal gut bacteria is crucial for treatment success.

Key Considerations

• The choice of treatment should be based on the severity of the infection, as well as the patient's medical history and risk factors for recurrence.
• The IDSA and SHEA guidelines provide a comprehensive framework for the treatment of C. diff infection, and should be consulted for specific recommendations and guidance 1.

From the FDA Drug Label

DIFICID® is indicated in adult and pediatric patients aged 6 months and older for the treatment of C. difficile-associated diarrhea (CDAD). The recommended dosage for adults is one 200 mg DIFICID tablet orally twice daily for 10 days. The recommended dosage for pediatric patients weighing at least 12.5 kg and able to swallow tablets is one 200 mg DIFICID tablet administered orally twice daily for 10 days.

The treatment for Clostridiium difficile (C. diff) infection is fidaxomicin (DIFICID), administered orally as follows:

• Adults: 200 mg twice daily for 10 days
• Pediatric patients (6 months to less than 18 years of age):
  • Weighing at least 12.5 kg and able to swallow tablets: 200 mg twice daily for 10 days
  • Unable to swallow tablets: dosed with DIFICID oral suspension according to weight-based recommendations 2

From the Research

Treatment Options for Clostridiium difficile (C. diff) Infection

• The primary treatment options for C. diff infection include fidaxomicin, vancomycin, and metronidazole 3, 4, 5.
• Fidaxomicin has been shown to be non-inferior to vancomycin in terms of clinical cure rates, and is associated with a significantly lower rate of recurrence 3, 6.
• Vancomycin is also an effective treatment option, but may have a higher rate of recurrence compared to fidaxomicin 3, 4, 6.
• Metronidazole is not recommended as a first-line treatment option due to its lower efficacy and higher rate of recurrence compared to fidaxomicin and vancomycin 4, 5.

Comparison of Treatment Outcomes

• A systematic review and network meta-analysis found that fidaxomicin and teicoplanin were significantly better than vancomycin in terms of sustained symptomatic cure 4.
• Another study found that fidaxomicin was associated with a 31% reduction in the risk of recurrence compared to vancomycin 6.
• The bactericidal properties of fidaxomicin make it an ideal alternative for C. diff treatment, but its high cost should be taken into account 7.

Considerations for Treatment

• The choice of treatment should be based on the severity of the infection, as well as the patient's medical history and risk factors for recurrence 5, 7.
• Fidaxomicin may be preferred over vancomycin to minimize the risk of recurrence, especially in patients with non-severe infections 6.
• The potential benefits and risks of treatment, as well as the cost of the medication, should be carefully considered when selecting a treatment option 7.