Re: 'the effect of antibiotic therapy for Clostridioides difficile infection on mortality and other patient-relevant outcomes' by Stabholz et al
Abstract
With great interest, we read the article by Stabholz and Paul on the effect of Clostridioides difficile infection (CDI) antibiotic therapy on mortality and other patient-relevant outcomes. The article highlighted the limitations of the evidence regarding CDI management particularly concerning death, severe complications, and the overall disease burden which includes its impact on daily activities and the total duration of diarrhoea.
We wholeheartedly agree that future clinical trials should give more consideration to patient-relevant outcomes. In line with this, a Desirability Of Outcome Ranking (DOOR) specifically designed for CDI based on panel discussions with both patients and physicians, has been proposed.
Ideally, there should be more adequately powered studies that are not funded or sponsored by the industry, to inform decision making. We acknowledge the authors' concern that the selection of outcome importance in the current ESCMID guidance document and the Infectious Diseases Society of American and Society for Healthcare Epidemiology of America (IDSA/SHEA) guideline may not have been transparent or clearly presented.
While both guideline committees made efforts to provide transparent documents, this issue warrants attention in the development of future guidance documents and guidelines.