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Am Fam Physician. 2022;105(6):678-679

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.


Key Points for Practice

• Fidaxomicin reduces recurrence compared with vancomycin for initial and recurrent CDI.

• For patients with recurrent CDI within six months, adding bezlotoxumab to antibiotics reduces further CDI recurrence.

• Fecal microbiota transplant risks transmitting potentially fatal infections, including E. coli and SARS-CoV-2.

From the AFP Editors

Clostridioides difficile infection (CDI) is a common cause of antibiotic-associated diarrhea. Although several treatment options exist, recurrence is common with treatment. This update from the Infectious Diseases Society of America (IDSA) weighs in on preferred first-line options for initial and recurrent infection.

Fidaxomicin Is Preferred

Although fidaxomicin (Dificid) leads to similar initial cure rates as vancomycin for CDI, fidaxomicin reduces recurrent infections. Treating an initial CDI with fidaxomicin instead of vancomycin prevents one additional recurrence at four weeks for every 10 patients treated (number needed to treat [NNT] = 10; 95% CI, 7 to 18). Treating recurrent CDI with fidaxomicin reduces recurrence at 30 days with an NNT of 7 (95% CI, 4 to 30) and at 90 days with an NNT of 5 (95% CI, 3 to 112) compared with vancomycin. 

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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