From the Guidelines
The optimal treatment approach for concurrent Urinary Tract Infection (UTI) and Clostridioides difficile (C. diff) infection is to treat the C. diff infection first with Fidaxomicin or Vancomycin, while also considering the treatment of the UTI with appropriate antibiotics.
Treatment of C. diff Infection
- For an initial C. diff episode, the preferred treatment is Fidaxomicin 200 mg given twice daily for 10 days, or Vancomycin 125 mg given 4 times daily by mouth for 10 days 1.
- For a first C. diff recurrence, the preferred treatment is Fidaxomicin 200 mg given twice daily for 10 days, or Vancomycin in a tapered and pulsed regimen 1.
- For multiple C. diff recurrences, treatment options include Fidaxomicin, Vancomycin in a tapered and pulsed regimen, Vancomycin followed by Rifaximin, and Fecal Microbiota Transplantation 1.
Treatment of UTI
- The treatment of the UTI should be based on the severity of the infection and the susceptibility of the causative organism to antibiotics.
- It is essential to choose an antibiotic that will not exacerbate the C. diff infection, such as Nitrofurantoin or Fosfomycin.
Important Considerations
- The treatment of C. diff infection should be prioritized, as it can be life-threatening if left untreated.
- The use of Bezlotoxumab as an adjunctive treatment for C. diff infection may be considered, but its use is limited by the availability of resources and the risk of congestive heart failure 1.
- Fecal Microbiota Transplantation is a recommended treatment option for patients with multiple recurrences of C. diff infection who have failed appropriate antibiotic treatments 1.
From the Research
Optimal Treatment Approach for Concurrent UTI and C. diff Infection
The optimal treatment approach for concurrent Urinary Tract Infection (UTI) and Clostridioides difficile (C. diff) infection involves careful consideration of the potential impact of antibiotics on the gut microbiota.
- A study published in 2017 2 found that a 3-day course of parenteral gentamicin was safe and effective in treating UTI in patients at high risk of C. difficile infection without perturbing their gut microbiota.
- Another study published in 2023 3 found that patients with recurrent UTI undergoing fecal microbiota transplantation (FMT) for recurrent C. difficile infection experienced a trend toward a decrease in frequency of UTI after FMT.
- A 2018 study 4 recommended using lower-risk antibiotics for UTI whenever possible, particularly in patients with a gastrointestinal comorbidity, to reduce the risk of C. difficile infection.
Treatment Options for UTI
Treatment options for UTI include:
- Nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole as first-line treatments, which have minimal collateral damage and resistance 5
- Beta-lactams, nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole as appropriate treatments in pregnancy 5
- Alternative approaches, such as fecal microbiota transplantation, may also be considered 3
Treatment Options for C. diff Infection
Treatment options for C. diff infection include:
- Metronidazole and vancomycin as mainstays of treatment for both the initial infection and the first recurrence 6
- A vancomycin course plus taper for second recurrences 6
- Alternative agents, such as fecal bacteriotherapy, rifaximin, nitazoxanide, probiotics, and intravenous immunoglobulin, for subsequent recurrences 6