What is the treatment for Clostridioides difficile (C. diff) and Campylobacter infections?

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DS

Dainyal Siddiqui, MD

Internal Medicine

MJ

Manuel Jimenez, MD

Cardiology

FP

Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 10, 2025 • View editorial policy

From the Guidelines

The treatment of Clostridioides difficile (C. diff) infection should prioritize fidaxomicin 200 mg twice daily for 10 days as the first-line treatment, while for Campylobacter infections, azithromycin 500 mg once daily for 3 days is recommended, considering the most recent guidelines from 1.

Key Considerations for C. diff Treatment

  • For initial C. diff episodes, fidaxomicin or vancomycin are preferred treatments, with metronidazole considered for non-severe cases 1.
  • Recurrent C. diff infections may require extended vancomycin regimens, fidaxomicin, or fecal microbiota transplantation, especially after multiple recurrences, as suggested by 2 and 3.
  • The choice of antibiotic should consider the severity of the infection, patient-specific factors, and local resistance patterns.

Key Considerations for Campylobacter Treatment

  • Azithromycin is the preferred treatment for Campylobacter infections, with ciprofloxacin as an alternative, though resistance patterns should be considered.
  • Severe cases of either infection may require hospitalization for intravenous antibiotics and supportive care.

Additional Recommendations

  • Fluid replacement and probiotics can aid in recovery and restore gut flora for both infections.
  • Treatment should begin promptly to prevent significant dehydration and potential life-threatening complications, especially in C. diff infections.
  • Fecal microbiota transplantation is recommended for patients with multiple recurrences of C. diff who have failed appropriate antibiotic treatments, as per 2 and 3.

Prioritizing Recent Evidence

The most recent guideline from 1 provides the basis for the recommended treatment approach for C. diff, emphasizing fidaxomicin as a first-line treatment. For Campylobacter, while specific recent guidelines are not provided, azithromycin remains a commonly recommended treatment based on its efficacy and resistance patterns.

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 C. difficile-associated diarrhea (CDAD) is Fidaxomicin (PO) with a recommended dosage of one 200 mg tablet orally twice daily for 10 days for adults, and varying dosages for pediatric patients based on weight.

  • Key points: + Fidaxomicin is used to treat C. difficile-associated diarrhea (CDAD). + The recommended dosage for adults is one 200 mg tablet orally twice daily for 10 days. + Pediatric patients have varying dosages based on weight. There is no information in the provided drug label about the treatment of Kempylobacter. 4

From the Research

Treatment of C-Diff

  • The treatment of Clostridium difficile (C. difficile) infection typically involves the use of antibiotics such as vancomycin, fidaxomicin, and metronidazole, although metronidazole is considered inferior 5, 6.
  • Fecal microbiota transplantation (FMT) is also a promising therapy for C. difficile infection, particularly for recurrent cases 5, 7, 8.
  • The cornerstones for the treatment of C. difficile infection are vancomycin and fidaxomicin, with metronidazole only recommended for mild-to-moderate disease in younger patients with no or few risk factors for recurrence 6.

Treatment Outcomes

  • A study comparing FMT with fidaxomicin and vancomycin found that FMT was superior in achieving clinical and microbiological resolution of recurrent C. difficile infection 7.
  • Another study found that a sequential FMT and antibiotic protocol had a high success rate in treating severe and severe-complicated C. difficile infection, with an overall treatment response of 93% 8.
  • Fidaxomicin has also been shown to be effective in treating C. difficile infection in patients with inflammatory bowel disease, with a treatment response of 60.6% 9.

Fecal Microbiota Transplantation

  • FMT is recommended for patients with frequently recurring C. difficile infection 6.
  • FMT has been shown to be effective in achieving clinical and microbiological resolution of recurrent C. difficile infection, with a success rate of 71% in one study 7.
  • FMT can be used as a rescue therapy for patients who do not respond to initial treatment with fidaxomicin or vancomycin 9.

Kempylobacter Treatment

  • There are no research papers provided to assist in answering the question about the treatment of Kempylobacter.

References

5
Research

Clostridium difficile infection: review.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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