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Recommendations are extrapolated from clinical experience and data pertaining to RCDI, as well as consideration of impaired gastrointestinal motility and ileus that occurs in these patients (32). Fidaxomicin, as mentioned previously, was not inferior to vancomycin for initial cure for CDI, but no data are available on the efficacy of this drug in severe or complicated disease.

Tigecycline is a novel analog of minocycline that exhibits broad antimicrobial activity against Gram-negative and Gram-positive organisms. Several published case reports suggest open-label benefit of intravenously administered tigecycline as a rescue strategy for the treatment of patients with severe CDI, in whom therapy with vancomycin and metronidazole has failed. However, further RCTs are required before we can make definitive recommendations regarding the use of tigecycline or fidaxomicin for the treatment of complicated CDI (68).