Expert Perspectives on Advances in the Management of C. Difficile - Episode 11

Choosing Between Vancomycin and Fidaxomicin for C. Difficile Infections

February 9, 2021
HCP Live


Peter L. Salgo, MD: Let me ask a simple yes/no question. I’m going to pick Paul. You’re on the hot spot. The data for recurrence with fidaxomicin [Dificid] versus vanco [vancomycin]; is fidaxomicin better? Is fidaxomicin better than vanco if you’re looking at recurrence, first infection?

Paul Feuerstadt, MD, FACG, AGAF: Fidaxomicin in terms of cost benefit?

Peter L. Salgo, MD: I don’t know, just the data for recurrence. I don’t care.

Paul Feuerstadt, MD, FACG, AGAF: Data for recurrence is relatively clear. There was a subgroup analysis from the original 2 phase 3 randomized controlled trials. It was published by Cornalee and colleagues, and within that there were 28% of the patients from the original pivotal trials that had an episode of C difficile within the prior 3 months. That group, the group that received vancomycin, went on to recur 35.5% of the time versus 19.7% in the fidaxomicin arm.

Peter L. Salgo, MD: OK. I rest my case, if I will.

Paul Feuerstadt, MD, FACG, AGAF: That’s a significant reduction in my eyes, but that data has been out for 9 years; there’s nothing new there. There are several what I consider very important studies that weren’t sided with the IDSA/SHEA [Infectious Diseases Society of America/Society for Healthcare Epidemiology of America] guideline update in 2020. The study that I like to talk about is a study by Goldenberg. It definitely did have some weaknesses, but it looked at the broad picture, which is an important thing to look at, where they compared a historical control group to the first year that fidaxomicin became available. They then looked at various health care systems that used fidaxomicin.

In 2 health care systems that decided to use fidaxomicin broadly, meaning every patient that had C difficile, 1 health care system’s recurrence rate went from 10.6% to 3.1%. The other, from 16.3% to 3.1%—remarkable decreases. But even in the health care system that used it for only for first recurrence, their recurrence rates went from 21.1% to 12.5%. What we’re seeing is no matter how fidaxomicin is being used, if a health care system commits to it, it seems to remarkably reduce those rates of recurrence, which really mimics what I call the ivory tower data, which is the phase 3 prospective, randomized, controlled trial data.

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.

Transcript Edited for Clarity