From the Guidelines
The treatment for Clostridioides difficile (C. diff) infection is primarily based on the severity of the disease and the number of recurrences.
Treatment Options
- For an initial episode of CDI, 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 recurrence of CDI, the preferred treatment is Fidaxomicin 200 mg given twice daily for 10 days or a tapered and pulsed regimen of Vancomycin 1.
- For second or subsequent recurrences of CDI, treatment options include Fidaxomicin, Vancomycin in a tapered and pulsed regimen, or Vancomycin followed by Rifaximin 1.
- For fulminant CDI, the recommended treatment is Vancomycin 500 mg 4 times daily by mouth or by nasogastric tube, with the addition of Metronidazole if ileus is present 1.
Fecal Microbiota Transplantation
- Fecal microbiota transplantation is recommended for patients with multiple recurrences of CDI who have failed appropriate antibiotic treatments 1.
- The use of fecal microbiota transplantation should be considered on a case-by-case basis, taking into account the patient's overall health status and the severity of their CDI 1.
Adjunctive Treatment
- Bezlotoxumab may be considered as an adjunctive treatment for patients with CDI who are at high risk of recurrence, but its use should be cautious in patients with congestive heart failure 1.
From the Research
Treatment Options for Clostridioides difficile (C. diff) Infection
- The primary treatment options for C. diff infection include vancomycin and fidaxomicin 2, 3, 4, 5.
- Metronidazole is no longer recommended as a first-line treatment due to its lower efficacy compared to vancomycin and fidaxomicin 3, 4, 5.
- Bezlotoxumab, a monoclonal antibody against C. difficile toxin B, may be considered as an adjunctive therapeutic strategy for patients with recurrent C. diff infection 2, 3, 5.
- Faecal microbiota transplantation (FMT) is effective and safe for the treatment of recurrent C. diff infection 2, 3, 5.
Severe-Complicated C. diff Infection
- For severe-complicated C. diff infection, the IDSA/SHEA recommends high-dose oral ± rectal vancomycin and IV metronidazole 2.
- The ESCMID has endorsed fidaxomicin and tigecycline as part of combination anti-C. diff therapy for severe-complicated infection 2.