Fidaxomicin versus metronidazole, vancomycin and their combination for initial episode, first recurrence and severe Clostridioides difficile infection — An observational cohort study. (February 2021)

• Record Type: Journal Article
• Authors: Polivkova, Sylvia; Krutova, Marcela; Capek, Vaclav; Sykorova, Blanka; Benes, Jiri
• Is Part Of: International journal of infectious diseases. Volume 103(2021)
• Page Start: 226
• Page End: 233
• Publication Date: 2021-02
• Subjects: Clostridioides difficile -- Fidaxomicin -- Vancomycin -- Metronidazole -- Recurrence -- Sustained clinical response; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.11.004
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: For 271 patients with Clostridioides difficile (CDI) clinical outcome was recorded (sustained clinical cure or recurrence). Fidaxomicin was a superior treatment to metronidazole or vancomycin in the initial episode. Fidaxomicin was a superior treatment to metronidazole or vancomycin in the first recurrence. Fidaxomicin was a superior treatment to metronidazole or vancomycin in non-severe CDI. Fidaxomicin had a similar treatment outcome to vancomycin in severe and multiple recurrent CDI. Abstract: Purpose: We aimed to evaluate the efficacy of different antibiotic regimens for the treatment of Clostridioides difficile infection (CDI) with regard to the CDI episode number and disease severity. Methods: An observation cohort study included 271 CDI patients hospitalised between 2013–2016. Univariate logistic regression was used to evaluate the association between patients' clinical outcome (sustained clinical cure or recurrence) in a 60-day follow-up and the antibiotic regimen used (oral metronidazole, oral vancomycin, combination of oral vancomycin and metronidazole, oral fidaxomicin). Subgroup analyses, based on CDI episode number and severity, were performed. Results: In the overall population, fidaxomicin was superior to metronidazole, vancomycin or their combination, for a sustained clinical response and in the prevention of recurrent CDI (rCDI). In the subgroup analyses, fidaxomicin was superior to vancomycin or metronidazole for a sustained clinical response and in the prevention of rCDI in the initial episode, first recurrence and non-severe cases. In the oral treatment of severe CDI, fidaxomicin had a similar treatment outcome to vancomycin and none of the antibiotic treatments were superior in the prevention of rCDI. Fidaxomicin, vancomycin, or a combination of metronidazole and vancomycin, had similar outcomes for sustained clinical response and prevention of rCDI in patients with multiple rCDI. Conclusion: Fidaxomicin was superior to metronidazole or vancomycin for the treatment of the initial episode, first recurrence, and non-severe CDI.