From the Guidelines
Yes, Dificid (fidaxomicin) can be taken both for active C. difficile infection and to prevent recurrence, as recommended by the 2021 clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1.
Key Points to Consider
- For active infection, the standard regimen is 200 mg taken twice daily for 10 days.
- For prevention of recurrence in high-risk patients, an extended-pulsed regimen may be used: 200 mg twice daily for 5 days, followed by 200 mg once every other day for 20 days (total treatment duration of 25 days).
- Dificid is particularly effective for preventing recurrence because it has minimal impact on normal gut bacteria while targeting C. difficile specifically, as shown in a randomized controlled trial comparing fidaxomicin to vancomycin 1.
- It remains in the intestinal tract with minimal systemic absorption, allowing it to maintain activity against C. difficile longer than other antibiotics.
- This medication should be taken with or without food at approximately the same times each day.
- If you're currently taking other antibiotics that may have triggered the C. difficile infection, you can generally continue them while on Dificid, but always consult your healthcare provider about your specific medication regimen.
Evidence Supporting the Use of Dificid
- A 2021 guideline recommends fidaxomicin over vancomycin for patients with an initial C. difficile infection episode, citing its beneficial effects and safety 1.
- A randomized controlled trial published in 2014 demonstrated that fidaxomicin had a higher sustained response rate compared to vancomycin, with 78% of patients achieving a sustained response with fidaxomicin versus 61% with vancomycin 1.
Important Considerations
- The choice of treatment should be individualized based on the patient's specific circumstances and medical history.
- Patients should be closely monitored for signs of recurrence or adverse effects while taking Dificid.
- Healthcare providers should consult the latest clinical guidelines and evidence-based recommendations when making treatment decisions for C. difficile infection.
From the Research
Treatment Options for CDI
- Fidaxomicin is a novel macrocyclic antibiotic approved for the treatment of Clostridium difficile infection (CDI) in adults 2.
- Vancomycin and fidaxomicin are recommended first-line therapies for CDI, but treatment failures and recurrences are not uncommon 3, 4.
- Extended-pulsed fidaxomicin (EPFX) has been proposed to reduce recurrence, especially in high-risk patients, though the evidence remains limited for those with multiple prior relapses 3.
Prevention of Recurrent CDI
- Fidaxomicin has been shown to be effective in preventing recurrent CDI when compared to a ten-day vancomycin course 5.
- Fecal microbiota transplantation (FMT) administered by nasogastric tube has also been shown to be effective in preventing recurrent CDI when compared to a fourteen-day vancomycin course and a fourteen-day vancomycin course plus bowel lavage 5.
- Monoclonal antibodies, such as actoxumab and bezlotoxumab, have also been shown to be effective in preventing recurrent CDI 5.