Fidaxomicin (Dificid) & C Difficile


Fidaxomicin (trade name Dificid) is a new type of antibiotic. It is taken orally and has a low impact on the bloodstream. It kills the target bacteria and has been shown to kill Clostridium difficile without attacking the many healthy bacteria found in the normal, healthy intestine. This in turn lessens the chance of further C Diff attacks.

Dificid and Dificlr

These are 2 of the trade names under which Fidaxomicin is marketed around the world. Studies looking at the effectiveness of the drug are common and links to these can be found below.

When is Fidaxomicin prescribed?

Because it is a recently developed drug Fidaxomicin is expensive. It is therefore likely to be prescribed when other C.difficile drugs have failed. Given the expense of treating C. difficile some make a case for prescribing it for moderate cases as the cost of prolonged treatment may be more than the short term cost of Fidaxomicin.

This is reinforced by a study that suggests that patients treated with Dificid shed less c difficile in their surroundings. This has a significant impact on transmission in the hospital context. This is clearly a positive for other patients but reductions in C Diff rates mean less likelihood of financial penalties from government bodies and will be a goal that insurers will want to encourage as it lowers their cost.

How does Fidaxomicin work?

Fidaxomicin has been developed by Optimer Pharmaceuticals. It works by inhibiting the bacterial enzyme RNA polymerase. This results in the death of the Clostridium difficile bacteria. This in turn means that further attacks are less common when treated with this drug.

Studies into length of treatment suggest that 5 days is barely enough. 20 days is too much with respect to a small number of other gut bacteria impacted by Dificid that need time to recover. Tapered dosing patterns both inhibit the infection and give the stomach flora some time to recover.

Are there known side effects?

Studies so far show these to be mild. They include ‘feeling hot’ and a daytime sleepiness condition called hypersomnia.

In depth medical background

For more technical information and the background to Fidaxomicin (Dificid) check Wikipedia

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9 thoughts on “Fidaxomicin (Dificid) & C Difficile

  1. Susan

    My mom is starting her 3rd course of treatment for C-Diff, a GI doc she saw told her to clean everything with Clorox including her hands! I know spores are not easily killed, but Clorox on skin?? He also told her that she should avoid other people, dining out or shopping. He made it sound like she has an aura of C-Diff surrounding her. The poor woman is going stir crazy being stuck in the house. Any help would be appreciated

    Reply
    1. admin Post author

      Unless the Clorox packaging suggests not being used on the skin then it should be fine to use it. Public contact does make her an infection risk while the infection is active but that is mainly going to be via the hands or with rest room use. Hand hygiene and timing toilet trips to occur while at at home should help. I’m not sure that the extreme isolation he suggests is normal advice. Some studies suggest that c diff colonization and active infection is very low in families so it should not be a huge risk out in the general population

      Dave Roberts
      cdifficile.org

      Reply
  2. mary

    If a person has a second attack of C Diff after using Fidaxomicin: is there a chance it will be effective if used a second time?

    It was used for the first time in May because Flagyl and Vancocin were no longer an option; now within eight weeks after using Fidaxomicin the first time, it appears C Diff might be back.

    Reply
    1. admin Post author

      Dificid is thought to be better at stopping repeat infections. There are other possibilities re the latest illness. It might be a new infection from a different source, they will need to test. Dificid failure might also suggest that the patient might benefit from a fecal transplant

      Dave Roberts
      cdifficile.org

      Reply
  3. MK Lathey

    I have had IBS for about 20 years. I self treated for about 10-12 years and been treated by MD since. We tried everything with only little help. Two years ago I was diagnosed with C-diff (no known cause) and it took 8 months to cure. I still had my IBS symptoms. Then 1 year ago I was diagnosed again with c-diff (this time after antibiotics). After 6 costly months of Vancomycin I was clear, but I still had my IBS symptoms which seemed to worsen. I tried to withstand the discomfort, but called the GI doc again. He ordered at ct (my 3rd in less than a year). All CTs showed signs of chronic colitis, but a colonoscopy showed not. I recently went for a 2nd opininion and had another colonoscopy, which tested positive for c-diff again, yet my colon lining showed no signs of it or colitis. What is going on? I am in very bad pain and cannot leave the house much due to my uncontrolable diarhea – I have many accidents. I am due to start a new antibiotic – Xifaxan 550. Will this help?
    Also, I have not had an appetite and eat very little, yet I have gained a bit of weight. I have been through stress lately – my son was injured in an accident 4/2007. After he came home from the hospital, I cared for him (in between many hospital stays that I stayed with him) until his death 3/2011. He was never diagnosed with c-diff – hes lost part of his colon and had a ileostomy. Any input you have is appreciated as I am tired of being sick and tired!!!

    Reply
    1. admin Post author

      The drug you have been prescribed is a common IBS drug. You may need to ask about Dificid as this seems to cut the re-occurence of C Diff.

      Dave
      cdifficile.org

      Reply
  4. Janet

    Hello,My Dad has C.Diff.He is 82yrs.He has been in the hospital and is home again.Dr’s have had him on antibiotics,but,to no avail.C.Diff.slows down and flares up again! What food can he eat with-out getting sick? I will be thank-full for what ever info you can
    give me.God Bless

    Reply
    1. admin Post author

      This from the http://www.uptodate.com/contents/patient-information-antibiotic-associated-diarrhea-clostridium-difficile site may help

      Diet — There is no particular food or group of foods that is best for a person with diarrhea. However, adequate nutrition is important during an episode of acute diarrhea. For patients without an appetite, it is acceptable to consume only liquids for a short period of time. Boiled starches and cereals (eg, potatoes, noodles, rice, wheat, and oats) with salt are recommended for people with watery diarrhea; crackers, bananas, soup, and boiled vegetables may also be eaten.

      A temporary type of lactose intolerance is common following diarrheal illness; this may last for several weeks to months. Thus, temporary avoidance of lactose-containing foods (eg, ice cream, milk and milk products) may be helpful.

      Reply

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