From the Guidelines
For suspected Clostridioides difficile (C. diff) infection, the preferred treatment is Fidaxomicin 200 mg given twice daily for 10 days, as it has been shown to be effective in resolving CDI symptoms and reducing the likelihood of recurrence. This recommendation is based on the most recent guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. The guidelines also suggest that Vancomycin 125 mg given 4 times daily by mouth for 10 days is an acceptable alternative treatment. It is essential to discontinue any unnecessary antibiotics that may have triggered the infection and implement contact precautions immediately, including a private room, glove and gown use, and thorough hand washing with soap and water since alcohol-based sanitizers are ineffective against C. diff spores.
Some key points to consider in the management of C. diff infection include:
- For initial CDI episode, Fidaxomicin and Vancomycin are the preferred and alternative treatments, respectively 1.
- For first CDI recurrence, Fidaxomicin and Vancomycin in a tapered and pulsed regimen are the preferred and alternative treatments, respectively 1.
- For second or subsequent CDI recurrence, Fidaxomicin, Vancomycin in a tapered and pulsed regimen, and Fecal microbiota transplantation are treatment options 1.
- For fulminant CDI, Vancomycin 500 mg 4 times daily by mouth or by nasogastric tube, and intravenously administered metronidazole 500 mg every 8 hours, should be considered 1.
It is crucial to note that the treatment of C. diff infection should be guided by the severity of the disease, the presence of recurrence, and the patient's underlying medical conditions. The guidelines provide a framework for the management of C. diff infection, but the treatment should be individualized based on the patient's specific needs and circumstances.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of DIFICID and other antibacterial drugs, DIFICID should be used only to treat infections that are proven or strongly suspected to be caused by C. difficile. DIFICID is indicated in adult and pediatric patients aged 6 months and older for the treatment of C. difficile-associated diarrhea (CDAD). Only use DIFICID for infection proven or strongly suspected to be caused by C. difficile.
For a suspected C. Diff case, fidaxomicin (PO) can be used as it is indicated for the treatment of C. difficile-associated diarrhea (CDAD) in adult and pediatric patients aged 6 months and older. The drug should only be used when the infection is proven or strongly suspected to be caused by C. difficile 2, 2, 2.
From the Research
Treatment Options for Suspected C. Diff
- The cornerstones for the treatment of CDI are vancomycin and fidaxomicin 3.
- Metronidazole should be used only in mild-to-moderate disease in younger patients who have no or only few risk factors for recurrence 3.
- In recurrent CDI, bezlotoxumab infusion (a monoclonal antibody against C. difficile toxin B) may be considered as an adjunctive therapeutic strategy in addition to the standard care provided to patients with several risk factors for recurrence 3.
- Faecal microbiota transplantation (FMT) should be offered to patients with frequently recurring CDI 3.
Comparison of Treatment Outcomes
- Fidaxomicin was superior to metronidazole, vancomycin or their combination, for a sustained clinical response and in the prevention of recurrent CDI (rCDI) 4.
- Fidaxomicin had a similar treatment outcome to vancomycin and none of the antibiotic treatments were superior in the prevention of rCDI in severe CDI cases 4.
- Fidaxomicin, vancomycin, or a combination of metronidazole and vancomycin, had similar outcomes for sustained clinical response and prevention of rCDI in patients with multiple rCDI 4.
- Fidaxomicin was inferior to metronidazole for recurrent CDI (rCDI) in one study 5.
Cost-Effectiveness of Treatment Regimens
- The preferred treatment regimen is fidaxomicin for nonsevere CDI, vancomycin for severe CDI, fidaxomicin for first recurrence, and FMT for subsequent recurrence, which is also cost-effective 6.
- Metronidazole is suboptimal for nonsevere CDI as it is less beneficial than alternative strategies 6.
- The most effective treatments, with highest cure rates, are also cost-effective due to averted mortality, utility loss, and costs of rehospitalization and/or further treatments for recurrent CDI 6.