KEY POINTS
- Fidaxomicin (Dificid) is a macrolide antibiotic that inhibits the RNA polymerase sigma subunit in susceptible organisms, which results in the inhibition of protein synthesis and cell death
- Only indicated for the treatment of diarrhea due to Clostridium difficile infection
- Not for use with systemic infection and has minimal systemic absorption
- Has a narrow spectrum activity, which is thought to reduce the ecological collateral damage of its use
- Has activity versus the NAP1/B1/027 strain of Clostridium difficile
- Typical dosing and duration in adults is 200mg oral twice daily x10 days
- Package insert does not give adjustments for renal or hepatic impairment
- Beware use in patients with macrolide allergy
- The most common side effect to beware is nausea
- Some other potential side effects are: gastrointestinal hemorrhage, abdominal pain, vomiting, anemia, and neutropenia
- Is considered a high-cost agent
RESOURCES
- Fidaxomicin Package Insert
- 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
- European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection [2014]
- Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) [2010]
- Lack of adherence to SHEA-IDSA treatment guidelines for Clostridium difficile infection is associated with increased mortality [2017]
- Rethinking Strategies to Select Antibiotic Therapy in Clostridium difficile infection [2016]
- Diagnosis and treatment of Clostridium difficile in adults: a systematic review [2015]
- Fidaxomicin: a novel macrolide antibiotic for Clostridium difficile infection [2014]
- Fidaxomicin: the newest addition to the armamentarium against Clostridium difficile infections [2012]
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