C. Difficile: Updates to Clinical Practice Guidelines


Implications regarding how to properly treat patients with C. difficile infections based on data that have emerged since clinical practice guidelines were last updated.

Peter L. Salgo, MD: New updates to the IDSA/SHEA [Infectious Diseases Society of America/Society for Healthcare Epidemiology of America] guidelines. You talked about 2018. Were you talking about updates after 2018? Is there something we need to know about now?

Thomas Lodise, PharmD, PhD: It’s part of the IDWeek 2020 provisional recommendations that were made. Since 2018, we have had 2 more vancomycin [Vancocin]-vs-fidaxomicin [Dificid] trials. The latter 2 were in hospitalized patients. What we found was very consistent with the older trials; patients with the fidaxomicin had much higher rates of sustained clinical response.

It was not so much they had an initial response; rather, it was a reduction in recurrence. Just from an understanding of the numbers, the number to treat was 10. For every 10 patients treated with fidaxomicin, you would get the 10-to-1 benefit with the additional treatment.

Also, what they did as a part of the guidelines is they now prioritized the fidaxomicin as the primary agent for patients with initial episodes as well as recurrence, because that same trend was observed. The number needed to treat with recurrences was 1 out of 5. Granted, most of the patients with the trial only had 1 recurrence.

Dale [Gerding, MD] can talk about this in greater detail because he’s the lead author on a paper, but there was additional recommendation with bezlo [bezlotoxumab] for individuals at high risk for recurrence; those over 65, immunosuppressed, have prior history of CDI [Clostridioides difficile infection]. For severe CDI, there’s also an indication to use that as part of therapy. These were some of the major changes and are provisional recommendations that are hot off the press and just presented at the 2020 IDWeek Meeting.

Peter L. Salgo, MD: You heard it here first.

Joseph Reilly, BS, PharmD, BCGP: Fidaxomicin seems to come to the forefront for treatments with the initial episode. When fidaxomicin came out, I don’t think many people were familiar with the term “sustained clinical response.” That seems to be the advantage of using fidaxo [fidaxomicin] in many patients, that they were less likely to have recurrences in a significant fashion. That number, depending on the data you looked at, was around 10 and drops down even lower, to around 7. I also think what was impressive with fidaxomicin data, based on some other studies that were published, is that it was better than vancomycin at 10 days for cure in patients who had cancer, or patients who were on concomitant antimicrobial therapy. Those are important considerations that we need to think about when we decide what agent we’re going to use in our patients.

Peter L. Salgo, MD: If you enjoyed this content, you should subscribe. We have an e-newsletter, and you can receive upcoming Peer Exchanges and other great content in your inbox—that’s right, electronically. I’ll see you next time. I’m Dr Peter Salgo. Thanks again for watching.

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