Fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid organ and hematopoietic stem cell transplantation with Clostridium difficile-associated diarrhea.

Clutter DS, Dubrovskaya Y, Merl MY, Teperman L, Press R, Safdar A.

Antimicrob Agents Chemother. 2013 Sep;57(9):4501-5.

The feasibility of fidaxomicin versus vancomycin and metronidazole (conventional
therapy) was assessed in 59 transplant recipients with 61 episodes of Clostridium
difficile-associated diarrhea (CDAD). Overall clinical cure was achieved in 86%
of episodes, and in 7% of episodes, infection recurred. Fidaxomicin was well
tolerated. Clinical cures were not significantly different compared with
conventional therapy (67% versus 89%, respectively; P = 0.06). Univariate
analysis of predictors for lack of clinical cure included continued use of
broad-spectrum systemic antibiotics (P = 0.026) and prior diagnosis of CDAD (95%
confidence interval, 1.113 to 19.569; odds ratio, 4.667; P = 0.041). New-onset
vancomycin-resistant Enterococcus (VRE) colonization was not noted after
fidaxomicin therapy alone. However, this occurred in 10 of 28 patients (36%)
following conventional therapy, and 2 of 3 patients with subsequent bacteremia
died.