From the Guidelines
For recurrent Clostridioides difficile (C. diff) infection, Dificid (fidaxomicin) prophylaxis is typically recommended for 20-40 days following the initial treatment course, as supported by the most recent guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. The standard approach is to complete a 10-14 day course of Dificid at the full therapeutic dose (200 mg twice daily), followed by a prophylactic regimen of 200 mg once daily or every other day for an additional 20-40 days. This extended prophylactic approach helps prevent recurrence by maintaining suppression of C. diff while allowing the normal gut microbiome to recover.
- Fidaxomicin works by inhibiting bacterial RNA polymerase and has the advantage of being narrow-spectrum with minimal disruption to the gut microbiota compared to other antibiotics.
- It also has a prolonged presence in the gut, which helps prevent C. diff spore germination.
- Patients should complete the full prophylactic course even if symptoms resolve quickly, and should continue any probiotics that may have been prescribed.
- Maintaining good hydration and avoiding unnecessary antibiotics during and after treatment is also important for preventing further recurrences, as emphasized in the clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the IDSA and SHEA 1. The most recent evidence from the 2021 focused update guidelines on management of Clostridioides difficile infection in adults suggests that fidaxomicin should be preferred over vancomycin for treating recurrent CDI, with a significant increase in sustained response at 30 days following end of therapy 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recurrent C. difficile Infection Treatment
- The treatment of recurrent C. difficile infection (CDI) is a complex issue, with various options available, including fidaxomicin, vancomycin, and fecal microbiota transplantation (FMT) 2, 3, 4.
- Fidaxomicin has been shown to be effective in treating recurrent CDI, with a study demonstrating that extended-pulsed fidaxomicin therapy can reduce recurrence rates in high-risk patients 2.
- However, FMT has been found to be superior to fidaxomicin for the treatment of recurrent CDI, with a randomized trial showing that FMT resulted in higher rates of clinical resolution and negative test results for C. difficile toxin 4.
Duration of Fidaxomicin Prophylaxis
- There is limited information available on the optimal duration of fidaxomicin prophylaxis for recurrent CDI.
- A study on extended-pulsed fidaxomicin therapy for recurrent CDI reported a treatment regimen of 200 mg twice daily for five days, followed by 200 mg every other day for 20 days 2.
- However, the ideal duration of fidaxomicin prophylaxis may vary depending on individual patient factors and the severity of the infection.
Comparison of Treatment Options
- A randomized trial comparing fidaxomicin with oral vancomycin for the treatment of CDI in hospitalized patients receiving concomitant antibiotics found similar rates of clinical cure and recurrence between the two groups 5.
- Another study found that FMT was superior to fidaxomicin and vancomycin for the treatment of recurrent CDI, with higher rates of clinical resolution and negative test results for C. difficile toxin 4.
- The choice of treatment for recurrent CDI should be based on individual patient factors, including the severity of the infection, medical history, and prior treatment responses 3, 6.