The choice of antibiotics for Clostridioides difficile infection (CDI) depends on the severity of the disease and the patient's clinical condition.
Non-severe disease
- Fidaxomicin: The ACG 2021 guidelines recommend oral fidaxomicin 200 mg BID for 10 days for patients with an initial episode of non-severe CDI
- Vancomycin: Oral vancomycin 125 mg QID for 10 days is recommended by the ESCMID 2021 guidelines as an alternative when fidaxomicin is not available or feasible
- Metronidazole: Oral metronidazole 500 mg TID for 10 days is recommended by the ACG 2021 guidelines in low-risk patients with an initial episode of non-severe CDI
Severe disease
- Fidaxomicin or vancomycin: The ASCRS 2021 guidelines recommend oral vancomycin or fidaxomicin as first-line therapy in patients with an initial episode of CDI
- Vancomycin: The IDSA/SHEA 2021 guidelines suggest oral vancomycin 125 mg QID for 10 days as an alternative to fidaxomicin in patients with an initial episode of CDI
Fulminant disease
- Vancomycin and metronidazole: The IDSA/SHEA 2018 guidelines recommend administering oral vancomycin 500 mg QID in patients with fulminant CDI. In addition, IV metronidazole 500 mg every 8 hours is recommended, particularly in patients with ileus
Ileus
- Vancomycin and metronidazole: The IDSA/SHEA 2018 guidelines recommend administering IV metronidazole 500 mg every 8 hours in addition to oral or rectal vancomycin in patients with ileus
In conclusion, the choice of antibiotic for CDI depends on the severity of the disease and the patient's clinical condition. The main antibiotics used are fidaxomicin, vancomycin, and metronidazole.