Partial Courses of Fidaxomicin Followed by Oral Vancomycin and the Effect on Recurrence of Clostridioides difficile Infections

Document Type

Article

Publication Date

5-6-2025

Publication Title

The Annals of pharmacotherapy

Abstract

BACKGROUND: Clostridioides difficile infection (CDI) causes a significant national health care burden. Literature has demonstrated lower rates of CDI recurrence with fidaxomicin compared with oral vancomycin. However, patients are sometimes switched to oral vancomycin before completing a fidaxomicin course.

OBJECTIVE: The objective of this study is to evaluate rates of CDI recurrence in full courses of fidaxomicin versus partial courses of fidaxomicin followed by a switch to oral vancomycin.

METHODS: In this single-center, retrospective, cohort study of adults with CDI, patients were screened for inclusion if they received either a full 10-day course of fidaxomicin or partial course of fidaxomicin followed by a switch to oral vancomycin. The primary outcome was the rate of CDI recurrence within 30 days after completion of initial therapy determined by a positive CDI test and initiation of treatment.

RESULTS: Ninety-nine patients received a full course of fidaxomicin, and 95 patients received a partial course of fidaxomicin followed by oral vancomycin. Mean age was lower in the full course group compared with the partial course (65.3 years vs 71.5 years, P < 0.002). Clostridioides difficile infection recurrence occurred in 5.1% of the full course group and 7.4% of the partial therapy group (P = 0.503) at 30 days and 13.1% versus 14.7% (P = 0.747) at 90 days. Clostridioides difficile infection-related readmissions at 30 days were similar in the full course and partial course groups (7.1% vs 4.2%, P = 0.389).

CONCLUSION AND RELEVANCE: Partial courses of fidaxomicin followed by oral vancomycin had similar 30-day CDI recurrence compared with full course fidaxomicin.

Medical Subject Headings

Humans; Fidaxomicin; Vancomycin/administration & dosage/therapeutic use; Clostridium Infections/drug therapy/prevention & control; Retrospective Studies; Male; Female; Aged; Anti-Bacterial Agents/administration & dosage/therapeutic use; Administration; Oral; Middle Aged; Clostridioides difficile; Aminoglycosides/administration & dosage/therapeutic use; Recurrence; Cohort Studies; Aged; 80 and over; Treatment Outcome; Clostridioides difficile; antimicrobial stewardship; vancomycin

PubMed ID

40326081

ePublication

ePub ahead of print

Volume

59

Issue

12

First Page

1094

Last Page

1100

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