New and Emerging Options for Treating Recurrent C difficile

This transcript has been edited for clarity.

Clostridioides difficile, or C diff for short, is a toxin-based infection that takes up residence in the colon due to disturbed normal bowel flora, usually after antibiotics.

Hi. I'm Paul Auwaerter with Medscape Infectious Diseases, here to talk to you about recurrent or relapsing C difficile, which can be a bedeviling problem for a subset of patients and their clinicians.

Recurrent C difficile can happen in up to a quarter of patients who receive oral vancomycin as a treatment for their infection. It can also occur with treatment with the newer agent, fidaxomicin, although possibly in fewer patients. In general, relapses are indeed common.

When I trained at Johns Hopkins under John Bartlett, he took the approach that after the second — and always after the third — relapse, an extended course of oral therapy with vancomycin could help get patients out of trouble. He used the so-called extended pulse method, where patients would take the drug for approximately 4-6 weeks and gradually reduce the dose.

This approach can also be done with fidaxomicin. However, I'm not sure it works much better than vancomycin, and there are often hurdles to using fidaxomicin due to insurers not approving it because of the expense.