Best Treatment for C. Difficile? Dificid or Vancocin

You’ll hear renewed debate about whether to use Vancocin or Dificid first to treat adults with Clostridioides difficile.

This is the new official name for C. diff…it replaces Clostridium difficile to better align groupings of similar bugs.

Oral vancomycin has been the go-to for initial treatment and recurrences of C. diff…due to better efficacy than metronidazole.

And fidaxomicin (Dificid) is often saved for patients who relapse after vancomycin…since it’s more costly.

Now hypothetical models rehashing old data suggest fidaxomicin is the most cost-effective choice for most initial and recurrent C. diff…due to fewer recurrences and lower overall healthcare costs.

But don’t expect this to upend practice. Any difference in overall costs…or length and quality of life…seems marginal.

Point out that fidaxomicin costs about $2,000 for 10 days, versus about $220 for vancomycin capsules…or under $5 for metronidazole.

Continue to recommend oral vancomycin for initial treatment of C. diff…or as an extended taper for a recurrent episode.

Reserve metronidazole for a mild initial infection if other meds aren’t an option…such as if vancomycin cost is a barrier. But avoid repeat courses due to dizziness, confusion, etc.

Generally save fidaxomicin (Dificid) as an option for patients with multiple C. diff recurrences…despite an extended vancomycin taper.

If patients have 3 or more C. diff episodes, expect some to try a fecal transplant…using proper protocols. Fecal transplants can resolve up to 90% of recurrences by restoring healthy GI flora.