Background The increasing prevalence, morbidity and mortality rates of Clostridium difficile infection (CDI) turn its treatment into a challenge for researchers. Fidaxomicin is a new treatment option which has been shown to be effective for treating both primary and recurrent CDI in clinical trials but there is limited clinical experience.
Purpose To evaluate the use and outcome in patients with CDI treated with fidaxomicin in a tertiary hospital.
Material and methods Between May 2013 and September 2014 patients undergoing treatment with fidaxomicin were assessed. Demographic and clinical data were collected from the patient electronic medical record. The outcome measure was Symptom-Free Interval (SFI), calculated in patients who were monitored for at least 1 month.
Results Thirteen patients were analysed (n = 13), 53.8% male, median age 54 years (range 27–83) and all had baseline disease which increased the risk of recurrent CDI, so fidaxomicin treatment was indicated by current clinical guidelines. Seven had a history of recurrent CDI and eleven had received previous treatment with vancomycin and/or metronidazole. Treatments with fidaxomicin were 200 mg twice daily for 10 days. Recurrence was found in 30.8% patients after the first treatment with fidaxomicin, but 6 patients were lost to follow-up (died). SFI varied with number of courses received. After the first treatment, the median SFI was 75 days (range 15–395). After the second course (2 patients) SFI was 66 and 180 days and following the third treatment (2 patients) SFI was 133 and 64 days.
Conclusion Use of fidaxomicin is more common in patients with recurrence or non-responders to standard treatment (84.6%); the recurrence rate was high (30.8%). This study was limited by the number lost to follow-up and high inter-individual variability in SFI. More clinical experience is needed to determinate which patients may benefit most. Alternative dose regimens should be considered to improve treatment outcomes.
References and/or Acknowledgements No conflict of interest
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