Retrospective evaluation of fidaxomicin versus oral vancomycin for treatment of Clostridium difficile infections in allogeneic stem cell transplant

Abstract

The findings of this study suggest that oral vancomycin and fidaxomicin are comparable options for CDI treatment in allogeneic SCT patients within 100 days following transplant.

Clinical and Economic Outcomes After Implementation of a Fidaxomicin Treatment Optimization and Access Pathway at a US Hospital System

“…Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea in developed countries, causing 30% of antibioticrelated diarrhea [1,2]. Patients are susceptible to CDI when there is disruption in the intestinal microbiome, often following long-term antibiotic use, gastric acid suppressant therapy, immunodeficiency, and increased age [2][3][4]. The Centers for Disease Control and Prevention 2019 Antibiotic Resistant Threats Report estimated that the incidence of CDI was 223,900 cases in hospitalized patients in 2017, with 12,800 deaths and a recurrence rate of 25%.…”

Impact of Updated Clinical Practice Guidelines on Outpatient Treatment for Clostridioides difficile Infection and Associated Clinical Outcomes

“…Again, the absolute reduction in CDI recurrence was similar to the randomized trials. While it should be noted that some observational studies conducted in certain high-risk groups [ 18 , 19 ] have not found a meaningful difference in outcomes between fidaxomicin and vancomycin, several other observational studies conducted by Goldenberg et al [ 20 ], Gallagher et al [ 21 ], and Polivkova et al [ 22 ] have demonstrated fidaxomicin’s superiority over vancomycin in treating CDI. The evidence on the superiority of fidaxomicin over vancomycin has also been acknowledged in the latest update to IDSA guidelines for CDI treatment published in 2021 [ 11 ], which now recommends fidaxomicin as first-line treatment for both initial and recurrent CDI episodes, with vancomycin an acceptable alternative.…”

Path of least recurrence: A systematic review and meta‐analysis of fidaxomicin versus vancomycin for Clostridioides difficile infection

“…Of the remaining 22 full-text articles reviewed, 14 studies (six RCTs and eight observational trials) met eligibility criteria for the final meta-analysis (Figure 1). [9][10][11][12][20][21][22][23][24][25][26][27][28][29][30] Reasons for excluding full-text articles included an unspecified follow-up period for recurrence, missing data, population overlap, and concomitant use of fecal microbiota transplantation. [31][32][33][34][35][36][37] For included RCTs, three studies were assessed to have a low risk of bias and three with some concerns, primarily due to problems related to the unblinding of standard-of-care treatments (Figure 2A).…”

“…The sensitivity analysis for removal of individual studies found over 10% reductions in heterogeneity with the removal of the Guery study (the only RCT evaluating fidaxomicin extended-pulsed dosing and the Polivkova study). 9,24 While these studies had the lowest Reports excluded: Adjunctive fecal microbiota transplantation (n=2) 32,33 Population overlap (n=1) 31 Missing data (n=3) 34,35,37 Unclear follow-up period (n=1) 36 Studies included in review (n=14) [9][10][11][12][21][22][23][24][25][26][27][28][29][30] Controlled trials (n=6) Observational trials (n=8)…”