A 40 year old female who works as a nurse aide in a long term rehabilitation center presents for abdominal pain and diarrhea. She describes greater than 3 episodes of loose, watery stool for the past 2 days with no vomiting or fever. Her vital signs are within normal limits. A Clostridium difficile stool toxin PCR is sent and results positive. According to the 2021 Infectious Disease Society of America guidelines, what is the preferred treatment for her condition?
A: IV vancomycin
B: PO fidaxomicin
C: PO metronidazole
D: PO vancomycin
Answer: PO fidaxomicin
The most recent IDSA guidelines for the treatment of non-fulminant Clostridium difficile diarrhea is fidaxomicin. It has shown superiority in preventing recurrence of disease when compared to oral vancomycin. Oral vancomycin or oral metronidazole are acceptable alternatives in non-fulminant disease and generally cost less than fidaxomicin. IV vancomycin is not used in the treatment of C. difficile diarrhea.
Treatment of Clostridium Difficile Diarrhea in Adults | |
---|---|
Initial, non-fulminant | Fidaxomicin preferred PO vancomycin alternative |
Recurrent, non-fulminant | Fidaxomicin or PO vancomycin |
Fulminant | PO vancomycin or via NG tube and IV metronidazole |
References:
Stuart Johnson, Valéry Lavergne, Andrew M Skinner, Anne J Gonzales-Luna, Kevin W Garey, Ciaran P Kelly, Mark H Wilcox, 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, Volume 73, Issue 5, 1 September 2021, Pages e1029–e1044, https://doi.org/10.1093/cid/ciab549