Treatment
Adult
➤ Discontinue therapy with the inciting antibiotic agent(s) as soon as possible,
as this may influence the risk of recurrence (S-M).
➤ Antibiotic therapy should be started empirically for situations where a
substantial delay in laboratory confirmation is expected, or for fulminant
CDAD* (W-L).
* Fulminant CDAD, previously referred to as severe, complicated CDAD, may be
characterized by hypotension or shock, ileus, or megacolon.
➤ Either vancomycin or fidaxomicin is recommended over metronidazole for an
initial episode.
Note: The dosage is: vancomycin 125 mg orally 4 times per day or fidaxomicin
200 mg twice daily for 10 days (S-H).
➤ In settings where access to vancomycin or fidaxomicin is limited, we suggest
using metronidazole for an initial episode of nonsevere CDAD* only (W-H).
The suggested dosage is metronidazole 500 mg orally 3 times per day for
10 days. Avoid repeated or prolonged courses due to risk of cumulative and
potentially irreversible neurotoxicity (S-M).
* See Table 2 for definition of severity.
➤ For fulminant CDAD,* vancomycin administered orally is the regimen of
choice (S-M). If ileus is present, vancomycin can also be administered per
rectum (W-L). The vancomycin dosage is 500 mg orally 4 times per day and
500 mg in approximately 100 mL normal saline per rectum every 6 hours
as a retention enema. Intravenously administered metronidazole should be
administered together with oral or rectal vancomycin, particularly if ileus is
present (S-M).
Notes: The metronidazole dosage is 500 mg intravenously every 8 hours.
* Fulminant CDAD is described above.
➤ If surgical management is necessary for severely ill patients, perform
subtotal colectomy with preservation of the rectum (S-M). Diverting loop
ileostomy with colonic lavage followed by antegrade vancomycin flushes is
an alternative approach that may lead to improved outcomes (W-L).
➤ Treat a first recurrence with oral vancomycin as a tapered and pulsed regimen
rather than a second standard 10-day course of vancomycin (W-L), OR;
➤ Treat a first recurrence with a 10-day course of fidaxomicin rather than a
standard 10-day course of vancomycin (W-M), OR;
Indication
DIFICID is a macrolide an bacterial drug indicated in adults (≥18 years of age) for treatment of
Clostridium difficile–associated diarrhea (CDAD).
To reduce the development of drug-resistant bacteria and maintain the effec veness of DIFICID
and other an bacterial drugs, DIFICID should be used only to treat infec ons that are proven or
strongly suspected to be caused by C difficile.
