First
recurrence
… Vancomycin 125 mg given qid
for 10 days if metronidazole
was used for the initial
episode, OR
W-L
Use a prolonged tapered and
pulsed vancomycin regimen if
a standard regimen was used
for the initial episode (e.g.,
125 mg qid for 10–14 days,
bid for a week, qd for a week,
and then q2–3d for 2–8
weeks), OR
W-L
Fidaxomicin 200 mg given
bid for 10 days if vancomycin
was used for the initial
episode
W-M
Second or
subsequent
recurrence
… Vancomycin in a tapered and
pulsed regimen, OR
W-L
Vancomycin, 125 mg qid PO
for 10 days followed by
rifaximin 400 mg tid for 20
days, OR
W-L
Fidaxomicin 200 mg given
bid for 10 days, OR
W-L
Fecal microbiota
transplantation
c
S-M
a
All randomized trials have compared 10-day treatment courses, but some patients (particularly those
treated with metronidazole) may have delayed response to treatment, and clinicians should consider
extending treatment duration to 14 days in those circumstances.
b
e criteria proposed for defining severe or fulminant CDAD are based on expert opinion. ese may
need to be reviewed in the future upon publication of prospectively validated severity scores for patients
with CDAD.
c
e opinion of the panel is that appropriate antibiotic treatments for at least 2 recurrences
(i.e., 3 episodes) should be tried prior to offering FMT.
Table 2. Recommendations for the Treatment of Adults (cont'd)
Clinical
Definition
Supportive
Clinical Data Recommended Treatment
a
Strength-Quality
dosage adjustments are recommended when co-administering fidaxomicin with substrates of P-gp
CYP enzymes.
impact of hepa c impairment on the pharmacokine cs of fidaxomicin has not been evaluated;
however, because fidaxomicin and its ac ve metabolite (OP-1118) do not appear to undergo
significant hepa c metabolism, elimina on of fidaxomicin and OP-1118 is not expected to be
significantly affected by hepa c impairment.
