Pearls from 3/29/2022 LEADS

Wednesday, March 30, 2022

The March 29, 2022, session of Duke Medicine LEADS featured Amy Barto, MD and Nicholas Turner, MD presenting "Update to C. difficile Treatment Guidelines." 


  • Fidaxomicin reduces the risk of C. difficile recurrence, but cost remains a barrier for many. Sending prescriptions early in hospital course through the Duke Cancer Center Pharmacy can help assure coverage. 
  • Bezlotoxumab is best given to outpatients and helps reduce recurrence risk in select patients at especially high risk for recurrence - mainly, age>/= 65, immunocompromised, prior C. difficile within the past 6 months, or severe C. difficile
  • Fecal microbiota transplantation (FMT) is allowable for patients who have experienced 1) at least 3 discrete episodes of C. diff infection (CDI), 2) two or more episodes of CDI associated with significant morbidity, 3) severe/fulminant CDI refractory to standard antibiotics.  
  • Routes of administration for FMT at Duke include colonoscopy-assisted FMT (GI) and frozen capsule FMT (ID).   Frozen capsule FMT is generally reserved for patients unable or unwilling to undergo colonoscopy-assisted FMT.
  • Patients with IBD are at increased risk for CDI, even in the absence of antibiotic use.
  • Secondary prophylaxis with low dose vancomycin can be used in patients at high risk for CDI recurrence who require future antibiotics for an unrelated infection or peri-operatively for a medical/dental procedure. 
  • Newer oral encapsulated microbiome-based products may soon supplant whole-stool based FMT as preferred treatment for CDI.


Watch the recorded session

Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.