HWN Suggests

C. Difficile Treatment: Fidaxomicin

It seems clear that this should be first-line; it’s associated with decreased recurrences, it has extra pharmacologic mechanisms, it can decrease the production of toxins, it can decrease sporulation, it has an active metabolite, it’s cidal. All of these examples; it causes less dysbiosis, even though patients with CDI may have dysbiosis just from the disease itself, and diarrhea. However, cost is an issue, and people were concerned about acquisition cost of a drug like that. When you look at the big picture, there is some data to say that the acquisition cost isn’t the primary concern, and that by using a potentially more expensive antibiotic you could wind up saving money in the long run…

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Articles of Interest

Dificid highly effective for treating C. difficile infection

Dificid, a newer antibiotic for treating Clostridium difficile infection, was highly effective for treating initial and recurrent infections, including in patients with inflammatory bowel disease, according to the results of a multicenter retrospective study.

DIFICID™ (fidaxomicin), a first-in-class antibiotic, now approved in Canada to treat C. difficile

DIFICID was superior to oral vancomycin in reducing CDI recurrence by 46% (recurrence rates 14.1% and 26.0% for DIFICID and vancomycin respectively p<0.001). DIFICID was also shown to be superior to vancomycin in sustaining clinical response for 28 days after treatment.

Fidaxomicin (Dificid) for Clostridium difficile Infection

Fidaxomicin decreases recurrence of C. difficile infection compared with vancomycin (number needed to treat [NNT] = 7 to 10), although it is no more effective in patients who are infected with a hypervirulent strain of C. difficile that is more likely to cause complications and recurrence.

Fidaxomicin (Dificid), a Novel Oral Macrocyclic Antibacterial Agent For the Treatment of Clostridium difficile–Associated Diarrhea in Adults

As its name suggests, Clostridium difficile–associated diarrhea (CDAD) is a common infection caused by the toxin-producing bacterium C. difficile. The infection can result in inflammation and cellular damage in the colon, leading to potentially severe complications, including enterocolitis with toxic megacolon, and possible death

Fidaxomicin Use and Clinical Outcomes for Clostridium difficile–Associated Diarrhea

In May 2011, the US Food and Drug Administration approved fidaxomicin for the treatment of CDAD. Fidaxomicin is a unique therapy for CDAD because it achieves high fecal concentrations with limited systemic absorption and limits C. difficile spore proliferation without pressuring the microbiome. 3–5 The recommended dose of fidaxomicin is 200 mg orally twice daily for 10 days with no dose reductions for special populations such as geriatrics or patients with renal or hepatic impairment. In this real-world setting, fidaxomicin resulted in a high rate of clinical success, a low rate of recurrence, and a low readmission rate.

Fidaxomicin versus Vancomycin for Clostridium difficile Infection

The major benefits of fidaxomicin in this comparative study with vancomycin were a 45% relative reduction in recurrences and a correspondingly improved rate of global cure, an outcome that is termed “symptomatic cure” by Nelson.

New Treatment for C. difficile Infection

So how could an antibiotic be effective against an illness caused by antibiotics? Dificid, a breakthrough treatment option, is a very narrow-spectrum antibiotic that works by killing C. difficile in the gut, suppressing the production of certain C. difficile toxins, and inhibiting the production of spores, while preserving the normal gut microbiome.

Resources

Dificid

DIFICID may be the answer to help treat your Clostridioides difficile infection (also known as C. diff).