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

Irene-Constantina Papamanolis1,2, Nicholas Stornelli1, Nathan Everson1,3

  • 1Carilion Roanoke Memorial Hospital, Carilion Clinic, Roanoke, VA, USA.

The Annals of Pharmacotherapy
|May 6, 2025
PubMed
Abstract

Insights

Switching from fidaxomicin to oral vancomycin before completing a full course of fidaxomicin (Clostridioides difficile infection) showed similar recurrence rates compared to completing the full fidaxomicin course.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Medicine

Background:

  • Clostridioides difficile infection (CDI) presents a substantial healthcare burden.
  • Fidaxomicin demonstrates lower CDI recurrence rates than oral vancomycin.
  • Patient management sometimes involves switching to oral vancomycin before completing fidaxomicin therapy.

Purpose of the Study:

  • To compare CDI recurrence rates between full fidaxomicin courses and partial fidaxomicin courses followed by oral vancomycin.

Main Methods:

  • Retrospective cohort study of adult patients with CDI.
  • Patients received either a full 10-day fidaxomicin course or a partial course switched to oral vancomycin.
  • Primary outcome: CDI recurrence within 30 days of therapy completion.

Main Results:

  • No significant difference in 30-day CDI recurrence between groups (5.1% full course vs. 7.4% partial course).
  • 90-day recurrence rates were also similar (13.1% vs. 14.7%).
  • CDI-related readmissions at 30 days were comparable between the two treatment strategies.

Conclusions:

  • Partial fidaxomicin courses followed by oral vancomycin are associated with similar 30-day CDI recurrence rates as full fidaxomicin courses.
  • This suggests potential flexibility in treatment duration for CDI management.
Keywords:
Clostridioides difficileantimicrobial stewardshipfidaxomicinrecurrencevancomycin

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