From the Guidelines
Fidaxomicin is the preferred antibiotic for treating Clostridioides difficile (C. diff) infection, particularly for initial episodes and recurrent cases.
Treatment Options
- For initial CDI episodes, fidaxomicin 200 mg twice daily for 10 days is recommended as the first-line treatment, with vancomycin 125 mg four times daily for 10 days as an acceptable alternative 1.
- In cases of recurrent CDI, fidaxomicin is again preferred, with options for a standard or extended-pulsed regimen, while vancomycin in a tapered and pulsed regimen or followed by rifaximin are also considered 1.
Comparison of Fidaxomicin and Vancomycin
- Studies have shown that fidaxomicin has a similar clinical cure rate to vancomycin for the first episode of CDI, but with a lower recurrence rate 1.
- Fidaxomicin is specifically developed for CDI treatment, with minimal systemic absorption and excellent in vitro activity against C. difficile 1.
Special Considerations
- For fulminant CDI, vancomycin 500 mg four times daily is recommended, with the option to add metronidazole intravenously in cases of ileus 1.
- Bezlotoxumab may be considered as an adjunctive treatment for patients at high risk of CDI recurrence, but its use depends on available resources and patient logistics 1.
From the Research
Antibiotic Treatment for C. diff Infection
The following antibiotics are used to treat Clostridioides difficile (C. diff) infection:
- Vancomycin: recommended as first-line therapy for most cases of CDI 2, 3, 4, 5
- Fidaxomicin: a good alternative, especially in patients at risk of relapse 2, 3, 4, 5, 6
- Metronidazole: may be used for mild-to-moderate disease in younger patients with no or few risk factors for recurrence, but has lower rates of treatment success compared to vancomycin and fidaxomicin 2, 3, 4, 5, 6
Comparison of Antibiotic Treatment Options
The choice of antibiotic treatment for CDI depends on various factors, including:
- Pharmacokinetic and pharmacodynamic properties: vancomycin and fidaxomicin reach high concentrations in stool, while metronidazole has low concentration in stool 5
- Risk of recurrence: fidaxomicin has a lower risk of recurrence compared to vancomycin and metronidazole 3, 4, 5, 6
- Antimicrobial stewardship: fidaxomicin has a narrow spectrum of antimicrobial activity, which may reduce the risk of recurrent CDI 5