Dr Douglas S. Paauw
A 64-year-old woman is evaluated for fever, diarrhea, and abdominal pain. She was diagnosed with Clostridioides difficile 2 months ago and completed a 10-day course of vancomycin. Her stool toxin test is positive for Clostridioides difficile (C. diff). Based on the most recent Infectious Diseases Society of America (IDSA) guidelines, what would be the preferred therapy?
A) MetronidazoleB) Fidaxomicin + bezlotoxumabC) VancomycinD) Fecal microbiota transplant
The recommendations from the 2021 guidelines would be to treat with fidaxomicin and add bezlotoxumab.1 The guidelines highlight the following changes:
In patients with an initial Clostridioides difficile infections (CDI) fidaxomicin is preferred over vancomycin.
In patients with a recurrent CDI episode, fidaxomicin is favored over vancomycin. For patients with multiple recurrences, vancomycin in a tapered and pulsed regimen, vancomycin followed by rifaximin, and fecal microbiota transplantation are options in addition to fidaxomicin.
Addition of bezlotoxumab to standard of care antibiotics is recommended for recurrence of CDI within the first 6 months over standard of care antibiotics alone
The feasibility of these recommendations is up for debate. The cost of a course of fidaxomicin is $2,800, and the cost of bezlotoxumab is about $4,500. Cost effectiveness studies that helped drive the recommendations show a savings by reducing future hospitalizations for
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COMMENTARY
Practice Guidelines Highlights From the Past Year
Douglas S. Paauw, MD
March 08, 2022
Dr Douglas S. Paauw
A 64-year-old woman is evaluated for fever, diarrhea, and abdominal pain. She was diagnosed with Clostridioides difficile 2 months ago and completed a 10-day course of vancomycin. Her stool toxin test is positive for Clostridioides difficile (C. diff). Based on the most recent Infectious Diseases Society of America (IDSA) guidelines, what would be the preferred therapy?
A) MetronidazoleB) Fidaxomicin + bezlotoxumabC) VancomycinD) Fecal microbiota transplant
The recommendations from the 2021 guidelines would be to treat with fidaxomicin and add bezlotoxumab.1 The guidelines highlight the following changes:
In patients with an initial Clostridioides difficile infections (CDI) fidaxomicin is preferred over vancomycin.
In patients with a recurrent CDI episode, fidaxomicin is favored over vancomycin. For patients with multiple recurrences, vancomycin in a tapered and pulsed regimen, vancomycin followed by rifaximin, and fecal microbiota transplantation are options in addition to fidaxomicin.
Addition of bezlotoxumab to standard of care antibiotics is recommended for recurrence of CDI within the first 6 months over standard of care antibiotics alone
The feasibility of these recommendations is up for debate. The cost of a course of fidaxomicin is $2,800, and the cost of bezlotoxumab is about $4,500. Cost effectiveness studies that helped drive the recommendations show a savings by reducing future hospitalizations for
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