Clostridium difficile is a gram-positive, spore forming bacteria normally transmitted by the fecal-oral route. Infection develops in patients with decreased normal gut flora and is typically associated with recent antibiotic use. Other risk factors include bowel surgery, compromised immune system function, extended hospital stays, and other underlying diseases. C. difficile bacteria produce two toxins, which cause increased intestinal fluid secretion and inflammation. Patients commonly present with diarrhea, abdominal discomfort, loss of appetite, and nausea. Current treatment guidelines are to discontinue antimicrobial agents and increase hydration. Less severe C. difficile associated diarrhea (CDAD) cases are treated with metronidazole 500 mg three times daily for 10 to 14 days and more severe cases treated with vancomycin 125 mg four times daily for 10 to 14 days. Recently, the FDA announced approval of Dificid® (fidaxomicin) for treatment of CDAD. Fidaxomicin is currently dosed 200 mg twice daily for 10 to 14 days. Several studies have shown fidaxomicin is non-inferior to vancomycin in treatment of CDAD. For the purpose of this article, we will further investigate CDAD treatment guidelines and the effectiveness of fidaxomicin.
McAllister SM, Crawford Z, Ilenin J, Hazelet E, Roecker AM. Fidaxomicin (Dificid®): New Antibiotic Approved for the Treatment of Clostridium difficile Infections. PAW Review. 2012 Jan 01; 3(1):Article 4 14-17 . Available from: https://digitalcommons.onu.edu/paw_review/vol3/iss1/4. Free full text article.