Fidaxomicin versus metronidazole, vancomycin and their combination for initial episode, first recurrence and severe Clostridioides difficile infection-an observational cohort study
Abstrakt
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 of CDI, 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 the initial CDI episode, first CDI recurrence and non-severe CDI for a sustained clinical response and in the prevention of rCDI.
In the oral treatment of severe CDI, fidaxomicin had a similar treatment outcome to vancomycin and none of the antibiotic treatments was superior in the prevention of rCDI. Fidaxomicin, vancomycin or a combination of metronidazole and vancomycin had similar outcomes in patients with multiple rCDI for a sustained clinical response and in the prevention of rCDI.
CONCLUSION: Fidaxomicin was superior to metronidazole or vancomycin for treatment of the initial episode, first recurrence and non-severe CDI.