Fidaxomicin could be 'first-line therapy' for certain recurrent C. diff patients

A study published in The Lancet Infectious Diseases examined treatments for non-multiply recurrent Clostridium difficile infections.

Researchers searched Medline, Embase, Web of Science, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for published and unpublished trials from inception until June 30, 2017. They identified randomized controlled trials of treatments for non-multiply recurrent infections with confirmed C. diff in adults that reported both primary cure and recurrence rate.

In total, researchers screened 23,004 trials, 24 of which were included in the study. The 24 trials comprised 5,361 patients and 13 different treatments.

For sustained symptomatic cure, researchers found fidaxomicin and teicoplanin were significantly better than vancomycin. Teicoplanin, ridinilazole, fidaxomicin, surotomycin and vancomycin were all better than metronidazole. Bacitracin was inferior to teicoplanin and fidaxomicin, while tolevamer was inferior to all drugs except LFF571 and bacitracin.

"Among the treatments for non-multiply recurrent infections by C. difficile, the highest quality evidence indicates that fidaxomicin provides a sustained symptomatic cure most frequently. Fidaxomicin is a better treatment option than vancomycin for all patients except those with severe infections with C. difficile and could be considered as a first-line therapy," study authors concluded.

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