Background and importance Clostridium difficile infection (CDI) can cause acute diarrhoea. One of the complications of CDI is recurrences. There are risk factors for multiple recurrences of the disease. Vancomycin and oral metronidazole are considered the treatment of choice. Other drugs, such as fidaxomicin and bezlotuxumab, may help in the control of recurrences.

Aim and objectives To analyse the use of fidaxomicin and bezlotuxumab in our hospital.

To analyse recurrences after treatment with fidaxomicin and early bezlotuxumab administration.

Material and methods Retrospective study including all patients treated with fidaxomicin from January 2014 to April 2021. Variables collected: age, gender, previous treatment (vancomycin/metronidazol), days and regimen of treatment, recurrence or death at 8 weeks. Risk factors evaluated: age >65 years, use of antibiotics in the previous 3 months, ICD in the last 6 months, severe disease (oncological patient, immunosuppressed, renal failure). Tapered dosage of fidaxomicin oral was defined as 200 mg/12 hours (5 days) and 200 mg/48 hours (D7–D25).

Data were obtained from the pharmacy dispensation program and the patients’ digital clinical records.

Results Forty-one patients were included, 25 women (61%), mean age 69 (21–99) years, 73.2% (n=30) were older than 65 years. 95.1% (n=39) had received antibiotics in the previous 3 months, 51.2% (n=21) had suffered CDI in the last 6 months, 60.9% (n=26) had severe baseline disease and 21.9% (n=9) were immunosuppressed. As first line, 41.4% (n=17) received vancomycin and metronidazole, 44% (n=18) received vancomycin and 14.6% (n=6) received fidaxomicin. 63.4% (n=26) received fidaxomicin 200 mg/12 hours (10 days), in 14.6% (n=9) the extended regimen was used and 22% (n=6) received 200 mg/12 hours for longer. 82.9% (n=34) of fidaxomicin-treated patients had no CDI recurrence at 8 weeks. 22% (n=9) of the patients died. Nine fidaxomicin-treated patients were administered bezlotuxumab and none subsequently developed CDI. All were older than 65 years and 66.6% (n=6) were oncology patients.

Conclusion and relevance The CDI treatment was mostly adjusted to the recommendedations in the therapeutic guidelines, with vancomycin/metronidazole as first-line and fidaxomicin in recurrences. The use of bexlotuxumab was adapted to the considerations of the Therapeutic Positioning Index and was used in patients with a higher risk of recurrence.

Although in the pivotal studies the recurrence rate with bexlotuxumab was 16.5%, in our study there were no recurrences. In the case of fidaxomicin, the recurrence rate was 17.1%, which was higher than the published studies.

Limitations: small sample size and the impact of the joint use of bexlotuxumab and fidaxomicin has not been measured.

Conflict of interest No conflict of interest