New data presented at the Federation of Infection Societies Conference (FIS) 2014, demonstrates that first-line use of fidaxomicin reduces recurrence of potentially-fatal Clostridium difficile infection (C. diff.) by 74%, compared to older therapies, vancomycin and metronidazole (10.6% vs. 2.8%). The study looked at all patients, and in the group of patients given fidaxomicin first-line there was a lower 28-day all-cause mortality compared with the other treatments (7.6% in those receiving fidaxomicin vs. 23.3% receiving vancomycin or metronidazole). Based on the results observed in this evaluation and the current levels of C. diff. found in the UK, first-line use of fidaxomicin could prevent more than 2000 recurrences of infection every year taking into account the current expected recurrences with vancomycin.
Commenting on the findings, Dr Simon Goldenberg, Consultant Microbiologist and Infection Control Doctor, Guy’s and St Thomas’ NHS Foundation Trust, said: “Today’s results show a genuine step change in the treatment of C. diff. It is gratifying to see this treatment performing in the real world as well it did in the clinical trial setting. From my experience of using fidaxomicin, it has the potential to benefit both patients and the NHS by preventing repeat infections and ultimately saving valuable NHS resources. In the last 10 years we have drastically reduced rates of C. diff. in the UK through stringent infection prevention measures; but now it’s time for a new approach to overall management of C. diff.”
Recurrence is a major challenge in CDI treatment, with up to 25% of all patients receiving vancomycin or metronidazole experiencing a return of infection within 4 weeks of initial therapy. This risk increases to 40% following a first recurrence, and continues to increase exponentially with each recurrence thereafter. In the real world evaluation, where patients suffered a first recurrence of CDI, 23.8% of those not receiving fidaxomicin had a second recurrence. This compared to only 6.7% of all patients receiving treatment with fidaxomicin.
Prof. Mark Wilcox, Consultant Microbiologist, Leeds Teaching Hospitals commented: “Preventing recurrence is a key goal of CDI management. Recurrence of CDI should be seen as a therapeutic failure. Today’s results demonstrating the capacity of fidaxomicin to markedly reduce recurrences in routine clinical practice are very encouraging, as are reductions in associated mortality.”
