C difficile: A Change in First-Line Treatment and New Biologic Agent

This transcript has been edited for clarity.

I'm Dr Neil Skolnik. Today we are going to talk about the Infectious Diseases Society of America's (IDSA's) 2021 Guidelines on Management of Clostridioides difficile Infection in Adults. There are some critically important changes to know about.

Fidaxomicin as First Line

Very simply and clearly, fidaxomicin is now recommended as the preferred agent for Clostridioides difficile infection (CDI) over vancomycin. Remember, in 2017 the IDSA guidelines recommended using vancomycin over metronidazole (Flagyl). The 2021 guideline suggests that for an initial CDI, fidaxomicin should be used rather than vancomycin.

Note that this is a conditional recommendation.

A "conditional recommendation" means that the IDSA used the rigorous GRADE approach to evaluate the evidence. In that rubric, the words "we suggest" indicate a conditional recommendation. What this means, as they explicitly state, is that vancomycin remains an acceptable alternative. The committee recognized that the cost of fidaxomicin is much greater than vancomycin. Implementation of the recommendation for fidaxomicin will depend on local available resources.

The rationale for this recommendation is that although initial clinical responses are similar for both agents, fidaxomicin increases the rate of sustainedresponse of CDI by 16% at 4 weeks after the end of therapy, compared with vancomycin.