From the Guidelines
Prophylaxis for Clostridium difficile (C. difficile) gastrointestinal infection is available and typically involves the use of oral vancomycin or fidaxomicin.
Key Points
- For patients at high risk of C. difficile infection, such as those undergoing antibiotic therapy, oral vancomycin 125mg four times daily for the duration of antibiotic therapy and up to 7-10 days after completion may be administered 1.
- Alternatively, fidaxomicin 200mg twice daily for 5-10 days may be used as prophylaxis in certain high-risk patient populations 2.
- Monoclonal antibodies such as bezlotoxumab may be considered for prophylaxis in patients with a history of recurrent C. difficile infection 2.
- Fecal microbiota transplantation (FMT) is an effective option for patients with multiple CDI recurrences who have failed appropriate antibiotic treatments 3, 4.
Considerations
- The decision to administer prophylaxis should be based on individual patient risk factors, such as history of recurrent CDI, severity of underlying disease, and exposure to antibiotics 1.
- The choice of prophylactic agent and duration of therapy should be guided by clinical judgment and consideration of the patient's specific risk factors and medical history 3, 2.
- Patients who have failed to resolve recurrent CDI despite repeated antibiotic treatment attempts may be considered for FMT 1, 3.
From the Research
Prophylaxis for Clostridium difficile Infection
There are several studies that have investigated the use of prophylaxis to prevent Clostridium difficile (C. difficile) gastrointestinal infection. The following points summarize the key findings:
- Oral vancomycin has been shown to be effective in reducing the risk of recurrent C. difficile infection (RCDI) in high-risk patients taking systemic antibiotics 5, 6, 7, 8.
- The optimal dosing regimen for oral vancomycin prophylaxis is not well established, but doses of 125 mg once or twice daily have been used in some studies 5, 8.
- Prophylaxis with oral vancomycin may have an adverse impact on the gastrointestinal microbiome, although this has not been extensively studied 5.
- Other prophylactic interventions, such as toxin-based vaccines and conventional probiotics, have not been shown to be effective in preventing C. difficile infection 9.
- Faecal microbiota transplantation (FMT) has been shown to be effective in treating patients with multiple recurrences of C. difficile infection, and may be considered for secondary prophylaxis in selected patients 9.
- Bezlotoxumab, a monoclonal antibody, has been shown to provide protection against RCDI, mainly in patients with primary episodes and a high risk of relapse 9.
Key Findings by Study
- A 2019 study published in The Annals of Pharmacotherapy found that oral vancomycin prophylaxis reduced the risk of RCDI in high-risk patients taking systemic antibiotics 5.
- A 2016 study published in The American Journal of Gastroenterology found that oral vancomycin prophylaxis decreased the risk of further recurrence in patients with a history of recurrent C. difficile infection 6.
- A 2019 study published in BMC Infectious Diseases found that prolonged oral vancomycin was effective in preventing further relapse in elderly patients with frequently relapsing C. difficile infection 7.
- A 2021 study published in Clinical Microbiology and Infection found that there are no proven effective, evidence-based prophylaxis options for primary C. difficile infection, but that FMT and bezlotoxumab may be considered for secondary prophylaxis in selected patients 9.
- A 2020 study published in Infection Control and Hospital Epidemiology found that oral vancomycin prophylaxis was effective in preventing recurrent C. difficile infection, but increased the risk of vancomycin-resistant Enterococcus spp colonization 8.