Novel Fidaxomicin Treatment Regimens for Patients With Multiple Clostridium difficile Infection Recurrences That Are Refractory to Standard Therapies.
Reports of fidaxomicin treatment for patients with multiple recurrent Clostridium difficile infections ([mrCDI] ie, more than 2 CDI episodes) indicate symptomatic response to this agent, but 50% have subsequent mrCDI episodes. In an effort to improve outcomes in patients with mrCDI we used novel regimens of fidaxomicin based on strategies used with vancomycin. Of 8 patients who received a 10-day chaser of fidaxomicin given twice daily after a course of vancomycin, 3 (38%) experienced a subsequent recurrence. Two (18%) of 11 patients who completed a 14- to 33-day course of fidaxomicin in a tapering dose experienced a recurrence, both of whom received additional antibiotics before that recurrence. The median symptom-free interval (SFI) after fidaxomicin taper was greater than the median SFI after the most effective prior regimen for those patients (257 days [interquartile range, 280] vs 25 days [interquartile range, 30], respectively; P = .003). A fidaxomicin chaser or taper regimen may be effective in patients with mrCDI, but the number of patients treated is small, and randomized comparative data are not available.
University of Illinois at Chicago College of Pharmacy ; Presence Resurrection Medical Center , Chicago, Illinois.
Melinda M
MM
Soriano
University of Illinois at Chicago College of Pharmacy.
Larry H
LH
Danziger
Hines Veterans Affairs Hospital , Illinois ; Loyola University Chicago Stritch School of Medicine , Maywood, Illinois.
Dale N
DN
Gerding
Hines Veterans Affairs Hospital , Illinois ; Loyola University Chicago Stritch School of Medicine , Maywood, Illinois.
Stuart
S
Johnson
Clostridium difficile infection; fidaxomicin; recurrence