Treatment of Clostridium difficile Infection

Introduction to Rifaksymina (Xifaxan)

• The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend rifaksymina as an option for treatment in cases of second or subsequent recurrences of C. difficile infection 1, 2, 3
• The strength of this recommendation is weak, with low-quality evidence 1, 2, 3

Treatment Regimens

• For second or subsequent recurrences, the treatment regimen includes vancomycin 125 mg orally four times a day for 10 days, followed by rifaksymina 400 mg three times a day for 20 days 1, 2, 3
• Alternative options for second or subsequent recurrences include vancomycin in a tapered and pulsed regimen, fidaksomicyna 200 mg twice a day for 10 days 3, or fecal microbiota transplantation (after at least two recurrences) 4

First Episode Treatment

• Rifaksymina is not recommended as monotherapy for initial treatment of C. difficile infection due to lack of data confirming its effectiveness in complicated or severe disease, and the risk of developing resistance 5
• Vancomycin or fidaksomicyna remain the first-line treatments for initial C. difficile infection 1, 2, 6

Special Populations

• In children with second or subsequent recurrences, rifaksymina may be used after vancomycin, but there is no established pediatric dosing 3, 4
• The recommended adult dosage is 400 mg three times a day, with a weak recommendation and very low-quality evidence 3, 4

Practical Summary

• Rifaksymina (Xifaxan) is an effective option for recurrent C. difficile infection, but only after standard vancomycin treatment and only from the second recurrence onwards 1, 2, 3
• It should not be used as first-line treatment or in monotherapy 5