Share on Facebook
Share on Twitter
Share on LinkedIn
Share by Email
Print
| C. DIFFICILE INFECTION TREATMENTS | ||||
|---|---|---|---|---|
| The following are FDA-approved therapies for the management of Clostridioides difficile infection (CDI) in adults. Off-label therapies and dosing are based on recommendations from the Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) for the management of CDI. | ||||
| Generic | Brand | Strength | Form | Adult Dose |
| FIRST CDI OCCURENCE1 | ||||
| Recommended | ||||
| fidaxomicin | Dificid | 200mg | tabs | 200mg twice daily for 10 days. |
| 40mg/mL | granules for oral susp | |||
| Alternative | ||||
| vancomycin2 | Vancocin | 125mg, 250mg | caps | 125mg 4 times daily for 10 days. |
| Firvanq | 3.75g, 7.5g, 15g | pwd for oral soln | ||
| metronidazole2,3 | Flagyl | 250mg, 500mg | tabs | Non-severe CDI: 500mg 3 times daily for 10−14 days. |
| RECURRENT CDI4 | ||||
| Recommended | ||||
| fidaxomicin | Dificid | 200mg | tabs | First and subsequent recurrence: 200mg twice daily for 10 days4. |
| 40mg/mL | granules for oral susp | |||
| Alternative | ||||
| vancomycin2 | Vancocin | 125mg, 250mg | caps | First recurrence: 125mg 4 times daily for 10 days5, or tapered/pulsed regimen4. Second or subsequent recurrence: tapered/pulsed regimen4, or 125mg 4 times daily for 10 days followed by rifaximin4. |
| Firvanq | 3.75g, 7.5g, 15g | pwd for oral soln | ||
| bezlotoxumab6 | Zinplava | 25mg/mL | soln for IV infusion | First and subsequent recurrence (adjunct): 10mg/kg once with standard of care antibiotics. Infuse over 60mins. |
| fecal microbiota spores, live-brpk7 | Vowst | — | caps | Recurrent CDI: 4 caps once daily for 3 consecutive days. Complete antibiotic treatment for recurrent CDI 2–4 days prior to intiation. Drink 10oz (296mL) magnesium citrate 1 day prior to and ≥8hrs prior to first dose of Vowst; avoid eating or drinking (except for small amount of water) for ≥8hrs prior to first dose. Take on empty stomach prior to first meal of the day. |
| fecal microbiota, live-jslm 7 | Rebyota | — | susp for rectal use | Recurrent CDI: For rectal use only. Empty bladder and bowel before administration. Give a single dose (150mL) 24–72hrs after the last dose of antibiotics for CDI. |
| NOTES | ||||
Key: CDI = Clostridioides difficile infection 1 The IDSA/SHEA clinical practice guideline on the management of CDI recommends fidaxomicin over vancomycin as the preferred treatment for the first occurrence of CDI due to its safety and efficacy profile. Vancomycin is an accepted alternative, and metronidazole may be used if fidaxomicin and vancomycin are unavailable. 2 For the treatment of fulminant CDI, defined as the presence of hypotension, shock, ileus, or megacolon, consult the IDSA/SHEA clinical practice guideline on the management of CDI for its recommendation on vancomycin and metronidazole use. 3 The use of metronidazole for CDI is not an FDA-approved indication, however, the IDSA/SHEA guideline recommends off-label use as an alternative for non-severe CDI (eg, WBC ≤15,000 cells/µL and serum creatinine <1.5mg/dL) if fidaxomicin and vancomycin are unavailable. 4 For alternative dosing (eg, fidaxomicin extended regimen, tapered/pulsed vancomycin regimen) and off-label therapies (eg, rifaximin, fecal microbiota transplantation) for recurrent CDI, consult the IDSA/SHEA clinical practice guideline on the management of CDI. 5 Consider standard dosing (125mg 4 times daily) if metronidazole was used for first CDI episode. 6 Use only in conjunction with antibacterial drug treatment of CDI to reduce CDI recurrence in patients at high risk for recurrence (eg, age ≥65yrs, immunocompromised [per history or use of immunosuppressants], and severe CDI on presentation). Caution in patients with CHF. 7Use after the completion of antibiotic treatment for recurrent CDI to prevent CDI recurrence.
Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. |
||||
| REFERENCE | ||||
|
Johnson S, Lavergne V, Skinner AM, Gonzales-Luna AJ, Garey KW, Kelly CP, Wilcox MH. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clinical Infectious Diseases. 2021;73(5):e1029–e1044. https://doi.org/10.1093/cid/ciab549. (Rev. 9/2023) |
||||
C. Difficile Infection Treatments
