Fidaxomicin therapy most effective during first episode of C. difficile infection
Patients with a first episode of Clostridium difficile infection (CDI) are likely to respond to treatment with fidaxomicin with no recurrences, a recent study has shown. On the other hand, those with prior CDI episodes are less likely to respond, especially with >1 prior episode, and more likely to recur, which suggests a greater clinical benefit of fidaxomicin earlier in the course of CDI.
There were 81 patients (median age 55.9 years; 53 percent female; 26 percent with inflammatory bowel disease) included in the study, of which 90 percent responded to fidaxomicin therapy. Prior CDI episodes were fewer (p=0.01) in responders (median, 1; range, 0‒8) vs nonresponders (median, 2.5; range, 1‒8). Response was 100 percent after a first CDI episode, 96 percent after one prior episode, and 82 percent after two or more (p=0.02).
There was a 19-percent recurrence rate. Patients who did not recur had fewer prior episodes of CDI (median 1; range 0‒6) than those with a recurrence (median, 2; range, 1‒8; p=0.005). Recurrence was 0 percent after a first episode, 23 percent after one prior episode, and 29 percent after two or more (p=0.005).
All patients with inflammatory bowel disease, as a response, either improved their symptoms or had a negative C. difficile test. Recurrence occurred in 19 percent.
The investigators included all CDI cases treated with fidaxomicin at three referral centres over a 4-year period. The definition of ‘response’ was resolution of diarrhoea, and ‘recurrence’ was defined by CDI recurrence within 8 weeks of the end of treatment.
“Fidaxomicin is a new antibiotic used to treat CDI,” according to the investigators.