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C. Difficile - Coggle Diagram

- - - - 125 mg orally 4 times daily for 10 days (FDA dosage) [5][6]
      - Initial episode, severe or nonsevere, 125 mg orally 4 times daily for 10 days (guideline dosage) [7]
      - Fulminant disease, 500 mg orally/NG tube 4 times daily plus IV metronidazole 500 mg every 8 hours; if complete ileus, consider adding vancomycin retention enema (500 mg in 100 mL NS) rectally every 6 hours (guideline dosage) [7]
      - First recurrence, vancomycin or fidaxomicin used in initial episode, use a prolonged tapered and pulsed regimen; for example, 125 mg orally 4 times daily for 10 to 14 days, twice daily for 1 week, once daily for 1 week, and then every 2 to 3 days for 2 to 8 weeks (guideline dosage) [7]
      - First recurrence, metronidazole used in initial episode, 125 mg orally 4 times daily for 10 days (guideline dosage) [7]
      - Second recurrence, 125 mg orally 4 times daily for 10 days, followed by rifaximin 400 mg orally 3 times daily for 20 days OR use a prolonged tapered and pulsed regimen; for example, 125 mg orally 4 times daily for 10 to 14 days, twice daily for 1 week, once daily for 1 week, and then every 2 to 3 days for 2 to 8 weeks (guideline dosage) [7].
  - - - Initial Episode: 200 mg PO BID q10 days
      - First recurrence: 200 mg PO BID q10 days OR 200 mg PO BID for 5 days followed by QOD for 20 days
      - Second or subsequent recurrence:
        
        fidaxomicin 200 mg PO BID q10 days
        
        fidaxomicin 200 mg PO BID q5 days followed by QOD for 20 days
        
        Vancomycin 125 mg 4 times daily PO q10days --> rifaximin 400 mg TID for 20 days
      - May be administered with or without food
    - - as a macrolide abx, it. inhibits RNA polymerase sigma subunit resulting in inhibition of protein synthesis and cell death in susceptible organisms including C. difficile; bactericidal
    - - Nausea (11%)
      - fever (children and adolescents) 13%
    - - Substrate of P-glycoprotein/ABCB1 (minor)
    - - •Take with or without food.
        •Keep taking this drug as you have been told by your doctor or other health care provider, even if you feel well.
        •Take a missed dose as soon as you think about it.
        •If it is close to the time for your next dose, skip the missed dose and go back to your normal time. don't take 2 doses at same time/extra doses
  - - - Special populations: Altered kidney function
      - CrCl ≤65 mL/minute: Half-life: 18 to 32 hours (hydroxy metabolite [active]) (Lamp 1999)
      - Special populations: Hepatic function impairment
      - Half-life: 18.31 hours (mean) in one study (Lau 1987)
      - According to Child-Pugh classification (Muscara 1995):
      - Child-Pugh class A: ~10.7 hours
      - Child-Pugh class B: ~13.5 hours
      - Child-Pugh class C: ~21.5 hours
  - - - Gastrointestinal: Nausea (7% )
      - Neurologic: Headache (4% )
      - Other: Fever (5% )
      - Serious: Heart Failure
- - - - Fidaxomicin 200 mg given twice daily for 10 days, OR twice daily for 5 days followed by once every other day for 20 days
      - Vancomycin 125 mg 4 times daily by mouth for 10 days followed by rifaximin 400 mg 3 times daily for 20 days
      - Fecal microbiota transplantation