title: The use of fidaxomicin for treatment of relapsed Clostridium difficile infections in patients with cancer.
abstract: OBJECTIVE
  To report our experience with the use of fidaxomicin (FDX), an oral macrocyclic antibiotic, in cancer patients with Clostridium difficile infection (CDI).
  
  
  METHODS
  A single-center retrospective case series was conducted at The University of Texas MD Anderson Cancer Center. Patients with CDI treated with FDX from May 2011 to January 2013 were identified via the pharmacy database. Clinical response and recurrence after FDX initiation were evaluated.
  
  
  RESULTS
  Twenty-two patients were included, most of whom were male (55%) with a mean age of 58 years (range: 20-83 yrs). The most common underlying malignancies were nine patients with lymphoma (41%), seven with leukemia (32%), and six with solid tumors (27%). Indications for FDX included recurrent CDI in 16 patients (72%) and failure of both metronidazole and oral vancomycin in 6 patients (28%). Nineteen patients (86%) were on concomitant antimicrobials during CDI treatment. Clinical response to FDX was 91%, and overall sustained clinical response was 82%. FDX was well tolerated with no major adverse events that were FDX related or discontinuations due to drug-related adverse events.
  
  
  CONCLUSIONS
  In cancer patients, FDX is effective treatment for the first episode of CDI after failure of standard therapies and treatment of recurrent CDI. This was interesting given the large number of high-risk patients who continued to receive concomitant antimicrobial therapy, which is common in this immunocompromised patient population.
authors.affiliation: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Amin
authors.initials: A
authors.lastname: Esmaily-Fard
authors.forename: Frank P
authors.initials: FP
authors.lastname: Tverdek
authors.forename: David M
authors.initials: DM
authors.lastname: Crowther
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Ghantoji
authors.forename: Javier A
authors.initials: JA
authors.lastname: Adachi
authors.forename: Roy F
authors.initials: RF
authors.lastname: Chemaly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002173:Cancer Care Facilities; D016360:Clostridioides difficile / Q000187:drug effects* / Q000276:immunology / Q000472:pathogenicity; D011307:Drug Prescriptions; D024901:Drug Resistance, Multiple, Bacterial; D057286:Electronic Health Records; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D005260:Female; D000077732:Fidaxomicin; D005572:Formularies, Hospital as Topic; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000276:immunology; D012008:Recurrence; D012189:Retrospective Studies; D013781:Texas; D055815:Young Adult
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000077732:Fidaxomicin
keywords: Clostridium difficile; cancer; fidaxomicin; infection; recurrence