From the Guidelines
If diarrhea continues after fidaxomycin treatment for C. difficile infection, consider switching to oral vancomycin 125 mg four times daily for 10-14 days, possibly followed by a tapered and pulsed regimen, as this approach has shown promise in managing recurrent CDI 1. When managing a patient with persistent diarrhea after fidaxomicin treatment, it's crucial to consider the potential for treatment failure, recurrence, or an alternative diagnosis. The decision to switch to vancomycin is supported by the 2021 focused update guidelines on management of Clostridioides difficile infection in adults, which suggest that fidaxomicin should be preferred over vancomycin for treating recurrent CDI, but also acknowledge the effectiveness of vancomycin in this setting 1. Key considerations in managing such cases include:
- Ensuring the patient stays hydrated and maintains electrolyte balance
- Repeating stool testing to confirm ongoing C. difficile infection
- Avoiding unnecessary antibiotics
- Considering probiotics supplementation
- Implementing infection control measures For severe or recurrent cases, adding bezlotoxumab (a monoclonal antibody against C. difficile toxin B) as a one-time infusion may help prevent recurrence. Fecal microbiota transplantation (FMT) is highly effective for multiple recurrences and should be considered if the patient has failed appropriate antibiotic therapy, with a strong recommendation and moderate quality of evidence supporting its use 1. The persistence of symptoms could be due to the severe disruption of gut microbiota, toxin-induced inflammation that takes time to resolve, or the presence of a resistant strain. Therefore, a comprehensive approach that includes supportive care, careful consideration of treatment options, and close monitoring is essential in managing patients with persistent diarrhea after fidaxomicin treatment for C. difficile infection.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diarrhea Continues After Fidaxomicin in C Diff
- Diarrhea continuing after fidaxomicin treatment for C. difficile infection is a significant concern, as it may indicate treatment failure or recurrence 2, 3, 4, 5, 6.
- Studies have shown that fidaxomicin is an effective treatment for C. difficile infection, but it may not be sufficient for patients with recurrent or refractory infections 2, 4, 5.
- In some cases, extended-pulsed fidaxomicin therapy may be effective in reducing recurrence, especially in high-risk patients 2.
- Fecal microbiota transplantation (FMT) has been shown to be superior to fidaxomicin for the treatment of recurrent C. difficile infection, with higher rates of clinical resolution and lower rates of recurrence 3, 6.
- The choice of treatment for C. difficile infection should be individualized based on the patient's specific needs and medical history, and may involve a combination of antibiotics, FMT, and other therapies 4, 5.
Treatment Options
- Fidaxomicin: effective for initial treatment of C. difficile infection, but may not be sufficient for recurrent or refractory infections 2, 4, 5.
- Extended-pulsed fidaxomicin therapy: may be effective in reducing recurrence, especially in high-risk patients 2.
- Fecal microbiota transplantation (FMT): superior to fidaxomicin for the treatment of recurrent C. difficile infection, with higher rates of clinical resolution and lower rates of recurrence 3, 6.
- Vancomycin: may be used in combination with FMT or as an alternative to fidaxomicin, but has lower rates of clinical resolution and higher rates of recurrence compared to FMT 3, 6.
Patient Factors
- Advanced age: may be a risk factor for treatment failure or recurrence 2.
- Active malignancy: may be a risk factor for treatment failure or recurrence 2.
- Prior treatment failures: may be a risk factor for treatment failure or recurrence 2, 4.
- Inflammatory bowel disease: may affect the efficacy of fidaxomicin treatment for C. difficile infection 4.