From the Guidelines
Outpatient treatment for Clostridioides difficile (C. diff) infection typically involves oral antibiotics, with fidaxomicin 200 mg twice daily for 10 days being the preferred treatment for an initial episode, 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. For an initial mild to moderate episode, oral vancomycin 125 mg four times daily for 10 days is also recommended.
- Key considerations for outpatient treatment include: + Completing the full course of antibiotics even if symptoms improve quickly + Staying well-hydrated + Avoiding anti-diarrheal medications which can worsen the condition + Practicing meticulous hand hygiene with soap and water since alcohol-based sanitizers don't kill C. diff spores + Close contacts practicing good hand hygiene
- Patients should contact their healthcare provider if symptoms worsen, if they develop high fever, severe abdominal pain, or signs of dehydration. These antibiotic regimens work by targeting the C. diff bacteria while allowing normal gut flora to gradually recover. After treatment, probiotics may help restore gut microbiome balance, though evidence for their effectiveness varies 2, 3. For patients with recurrent C. diff infection, treatment options include vancomycin, fidaxomicin, and fecal microbiota transplantation (FMT), with the choice of treatment depending on the severity of the infection and the patient's medical history 4, 3. It's essential to note that FMT has shown promise in treating recurrent C. diff infection, but its use is generally reserved for patients who have failed multiple courses of antibiotic treatment 3. In terms of specific treatment regimens, fidaxomicin 200 mg twice daily for 10 days is recommended for an initial episode of C. diff infection, while vancomycin 125 mg four times daily for 10 days is an alternative option 1. For recurrent C. diff infection, vancomycin 125 mg four times daily for 10 days followed by a tapered and pulsed regimen, or fidaxomicin 200 mg twice daily for 10 days, are recommended treatment options 1, 3. Ultimately, the choice of treatment should be individualized based on the patient's specific needs and medical history, and guided by the most recent and highest-quality evidence available 1, 2, 4, 3.
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).
Outpatient treatment of C. difficile-associated diarrhea (CDAD) is possible with fidaxomicin (PO), as it is indicated for the treatment of CDAD in adult and pediatric patients aged 6 months and older 5.
- Key points: + Fidaxomicin is used to treat CDAD + It can be used in outpatient settings + It is indicated for patients aged 6 months and older
From the Research
Outpatient C Diff Treatment Options
- Vancomycin is proposed as the first choice for antibiotic treatment of C. difficile infection (CDI) when necessary 6
- Fidaxomicin is a good alternative, especially in patients at risk of relapse 6
- Metronidazole is mentioned as a first-line therapy, but its use is not recommended as a first choice 6
- Faecal microbiota transplantation (FMT) is a effective therapy for multiple recurrent CDI, with a high success rate of 93% 7
- FMT can be used in combination with vancomycin for severe and severe/complicated CDI, with a success rate of 93% 7
Treatment Outcomes
- Fidaxomicin led to resolution of CDI in 60.6% of patients with inflammatory bowel disease, with 30% developing a recurrence at a median of 55 days 8
- FMT was an effective therapy for patients who did not respond to fidaxomicin, with resolution of CDI in 76.9% of patients 8
- Vancomycin and FMT can ameliorate CDI-induced clinical features and intestinal tissue damage, with FMT replenishing intestinal microbiota and eliminating the abundance of the phylum Proteobacteria 9
- Fidaxomicin was inferior to metronidazole for recurrent CDI, with increased odds of suffering another episode of CDI 10