What are the guidelines from Alberta, Canada for the treatment of Clostridioides difficile (C. diff) infection?

From the Research

Alberta, Canada's guidelines for treating Clostridioides difficile (C. diff) infection recommend a stepwise approach based on disease severity and recurrence, with oral vancomycin 125 mg four times daily for 10-14 days as the first-line treatment for initial mild to moderate cases, as supported by the most recent study 1.

Treatment Approach

For initial mild to moderate cases, the recommended treatment is:

• Oral vancomycin 125 mg four times daily for 10-14 days
• Fidaxomicin 200 mg twice daily for 10 days is an alternative first-line option, particularly effective at reducing recurrence, as shown in a study comparing fidaxomicin to metronidazole, vancomycin, and their combination 1

Severe Cases

For severe cases, the same vancomycin regimen is used, but with consideration for higher doses (up to 500 mg four times daily), as suggested by a study comparing vancomycin to metronidazole in severe cases 2

Fulminant Cases

For fulminant C. diff with complications like hypotension or ileus, intravenous metronidazole 500 mg every 8 hours should be added to oral or rectal vancomycin

Recurrence

For first recurrence, the same regimen as the initial episode is typically used, while for multiple recurrences, extended vancomycin pulse-taper regimens (gradually decreasing frequency over several weeks) or fidaxomicin are recommended, as supported by a study on the treatment of recurrent CDI 3

Fecal Microbiota Transplantation

Fecal microbiota transplantation is considered for patients with multiple recurrences who have failed appropriate antibiotic treatments, as recommended by a study on the treatment of CDI 4

Supportive Care

Supportive care includes:

• Fluid and electrolyte replacement
• Avoiding antimotility agents
• Implementing infection control measures like contact precautions and hand hygiene with soap and water
• Discontinuation of the inciting antibiotic and any unnecessary antibiotics or proton pump inhibitors is crucial whenever possible to help restore normal gut flora, as emphasized in a review of CDI treatment options 5