Fidaxomicin: a new option for the treatment of Clostridium difficile infection

The two drugs currently recommended for the treatment of Clostridium difficile infection (CDI), namely vancomycin and metronidazole, are both associated with high rates of recurrence of infection. Hence there is a need for new treatment options. The novel oral macrocyclic antibiotic fidaxomicin (previously known as PAR-101, OPT-80 and difimicin) was recently approved in the USA and in Europe for the treatment of CDI. Clinical trials have shown non-inferiority with regard to clinical cure when compared with oral vancomycin, and reduced rates of recurrence of infection, with a concomitant increase in the overall rate of sustained response, although improved sustained response was not seen in the sub-group of patients infected with the C. difficile NAP1/B1/027 strain. The introduction of fidaxomicin extends the options for the treatment of CDI and may help to reduce the burden of this disease if fewer patients have recurrence of infection.