From the Guidelines
For the treatment of Clostridium difficile NAP1/BI/027, fidaxomicin 200 mg given twice daily for 10 days is the preferred treatment for initial episodes, as it has been shown to reduce recurrence rates compared to vancomycin 1.
Treatment Options
- For initial episodes of CDI, fidaxomicin 200 mg twice daily for 10 days is recommended as the first-line treatment, due to its ability to reduce recurrence rates compared to vancomycin 1.
- Vancomycin 125 mg given 4 times daily for 10 days is an alternative treatment option for initial episodes of CDI, particularly if fidaxomicin is not available 1.
- For recurrent CDI, a tapered and pulsed vancomycin regimen or fidaxomicin 200 mg twice daily for 10 days can be used, with the addition of bezlotoxumab 10 mg/kg given intravenously once during administration of standard of care antibiotics for high-risk patients 1.
Special Considerations
- For fulminant CDI, vancomycin 500 mg 4 times daily by mouth or by nasogastric tube, with or without rectal instillation, and intravenous metronidazole 500 mg every 8 hours, is recommended 1.
- Fecal microbiota transplantation can be considered for patients with multiple recurrences of CDI who have failed appropriate antibiotic treatments 1.
Infection Control
- Infection control measures, including contact precautions, hand hygiene with soap and water, and environmental cleaning with sporicidal agents, are essential to prevent transmission of C. difficile NAP1/BI/027 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
C diff nap 027 Overview
- C diff nap 027, also known as the BI/NAP1/027 strain, is a hypervirulent strain of Clostridium difficile that has been implicated in outbreaks associated with increased morbidity and mortality 2, 3, 4.
- This strain is characterized by higher than usual toxin A and B production, the presence of a third toxin, binary toxin, and high-level resistance to fluoroquinolone antibiotics 2.
- The BI/NAP1/027 strain has been found to be resistant to fluoroquinolones, which is likely to contribute to its dissemination 2, 3.
Treatment and Recurrence
- Fidaxomicin has been shown to be effective in inhibiting spore production in C. difficile, including the epidemic NAP1/BI/027 strain, which may contribute to its superior performance in sustaining clinical response and reducing recurrences 5.
- Vancomycin treatment is more effective than metronidazole for severe CDI, while for mild disease either agent can be used 2.
- Recurrent CDI is often caused by the same strain as the original episode, with a higher rate of recurrence found in patients infected with the BI/NAP1/027 strain 6.
Epidemiology and Risk Factors
- The BI/NAP1/027 strain has been found to be more common in elderly hospitalized patients, with advanced age, hospitalization, and exposure to specific antimicrobials, especially fluoroquinolones and cephalosporins, being major risk factors for infection 2, 3.
- Asymptomatic carriers admitted to healthcare facilities can transmit the organism to other susceptible patients, thereby becoming vectors 3.
- Fulminant colitis is reported more frequently during outbreaks of C. difficile infection in patients with inflammatory bowel disease (IBD) 3.