Alternatives to Dificid If You Can't Fill Your Prescription

Your doctor prescribed Dificid (Fidaxomicin) for a Clostridioides difficile infection — but now you're finding out it's not available at your pharmacy, or the cost is more than you can handle. What are your options?

The good news is that there are several effective alternatives to Dificid for treating C. diff. In this guide, we'll explain how Dificid works, then walk you through the real alternatives your doctor may consider.

Important: Never switch medications on your own. Always talk to your doctor before changing your treatment plan.

What Is Dificid and How Does It Work?

Dificid is the brand name for Fidaxomicin, a macrocyclic antibiotic. It works by blocking an enzyme called RNA polymerase in C. difficile bacteria, which stops the bacteria from making the proteins they need to survive. This kills the C. diff bacteria.

What makes Dificid special is its narrow spectrum. Unlike many antibiotics that kill a wide range of bacteria (including your healthy gut bacteria), Dificid primarily targets C. diff while leaving most of your normal gut flora intact. This is why Dificid has a significantly lower recurrence rate — about 15% compared to 25% with Vancomycin.

For a deep dive into how Dificid works, read our article: How Does Dificid Work? Mechanism of Action Explained.

A standard course is 200 mg twice daily for 10 days. It can be taken with or without food. Learn more about dosing in our complete Dificid guide.

Alternative 1: Oral Vancomycin

Oral Vancomycin is the most common alternative to Dificid and is considered equally first-line for C. diff treatment according to the 2021 IDSA/SHEA guidelines.

How it works: Vancomycin is a glycopeptide antibiotic that kills bacteria by disrupting their cell wall synthesis. When taken orally, it stays in the gut and targets C. diff directly.

Typical dose: 125 mg by mouth four times daily for 10 days.

Pros:

• Much more affordable — oral Vancomycin capsules typically cost $300 to $600 for a 10-day course, and compounded liquid forms can be even cheaper
• Widely available at most pharmacies
• Well-established track record of effectiveness
• Guideline-recommended first-line therapy alongside Fidaxomicin

Cons:

• Higher recurrence rate (~25%) compared to Dificid (~15%)
• Broader effect on gut microbiome
• Common side effects include nausea, abdominal pain, and fever

For many patients, oral Vancomycin is an excellent and accessible alternative, especially for a first episode of C. diff.

Alternative 2: Metronidazole (Flagyl)

Metronidazole (brand name Flagyl) was once the go-to treatment for C. diff, but it has been downgraded in current guidelines. It's now recommended only when Vancomycin and Fidaxomicin are not available.

How it works: Metronidazole enters bacterial cells and disrupts their DNA, killing the bacteria. Unlike oral Vancomycin and Fidaxomicin, Metronidazole is absorbed into the bloodstream, which means it can cause more systemic side effects.

Typical dose: 500 mg by mouth three times daily for 10 days.

Pros:

• Very inexpensive — often under $20 for a full course
• Available at virtually every pharmacy
• Can be useful when other options are truly unavailable

Cons:

• Lower cure rates than Vancomycin or Fidaxomicin
• No longer recommended as first-line therapy
• More side effects including nausea, metallic taste, peripheral neuropathy
• Cannot be mixed with alcohol

Alternative 3: Bezlotoxumab (Zinplava)

Bezlotoxumab (brand name Zinplava) is a different kind of treatment. It's a monoclonal antibody given as a single IV infusion that targets the toxin produced by C. diff rather than the bacteria itself.

Important: Bezlotoxumab is not a standalone treatment. It's used alongside an antibiotic (like Vancomycin) to reduce the risk of C. diff recurrence.

Pros:

• Significantly reduces recurrence risk when added to standard antibiotic therapy
• Single infusion — no pills to remember

Cons:

• Given by IV infusion in a healthcare setting
• Very expensive (often over $4,000)
• Does not replace antibiotic treatment — must be used in combination

Bezlotoxumab may be a good option if you're at high risk for recurrent C. diff, such as if you're over 65, immunocompromised, or have had prior episodes.

Alternative 4: Microbiome-Based Therapies (Vowst, Rebyota)

For patients dealing with recurrent C. diff infections, newer microbiome-based therapies offer a different approach.

Vowst (Fecal Microbiota Spores, Live — Oral) is an oral capsule containing purified bacterial spores from healthy donor stool. It's designed to restore healthy gut bacteria after antibiotic treatment for recurrent C. diff.

Rebyota (Fecal Microbiota, Live) is a rectally administered product with a similar goal — restoring the gut microbiome to prevent C. diff from coming back.

Important: These are not first-line treatments. They are used after you complete antibiotic therapy for a recurrent C. diff infection.

Pros:

• Address the root cause of recurrence (disrupted gut microbiome)
• Vowst is taken orally — no procedures needed
• High efficacy in preventing further recurrences

Cons:

• Only for recurrent infections, not initial episodes
• Expensive and may require prior authorization
• Relatively new treatments with less long-term data

Which Alternative Is Right for You?

The best alternative depends on your specific situation:

• First episode of C. diff: Oral Vancomycin is the most practical alternative and is equally recommended as first-line therapy
• Cost is the main barrier: Ask about generic Fidaxomicin ($1,290–$1,800 with coupons) or oral Vancomycin ($300–$600)
• Recurrent C. diff: Your doctor may consider Fidaxomicin (if obtainable), Bezlotoxumab as add-on therapy, or microbiome therapies like Vowst
• Availability is the issue: Before switching medications, try using Medfinder to locate Dificid at nearby pharmacies, or read our guide to finding Dificid in stock

Final Thoughts

Dificid is an excellent medication for C. diff, but if you can't get it, you have viable options. Oral Vancomycin remains a strong first-line alternative, and newer therapies like Bezlotoxumab and microbiome-based treatments offer hope for patients with recurrent infections.

Talk to your doctor about the best alternative for your situation, and don't delay treatment — C. diff infections can worsen quickly without proper medication. If you want to keep trying for Dificid, search on Medfinder to find a pharmacy near you that has it available.