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Rethinking Strategies to Select Antibiotic Therapy in Clostridium difficile infection
Author(s) -
Chopra Teena,
Goldstein Ellie J.C.,
Gorbach Sherwood L.
Publication year - 2016
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1863
Subject(s) - fidaxomicin , clostridium difficile , metronidazole , medicine , intensive care medicine , disease , vancomycin , antibiotics , biology , bacteria , microbiology and biotechnology , genetics , staphylococcus aureus
In recent years, Clostridium difficile infection ( CDI ) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. Current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective components not well delineated across treatment algorithms and clinical trials. Furthermore, there is little evidence linking severity at onset to outcome. However, reducing the risk of recurrence may offer both a better outcome for the individual and decreased downstream economic impact. The authors present data supporting the opinion that patients deemed at low risk for recurrence should receive vancomycin (or metronidazole when cost is an issue), while those at higher risk of recurrence would benefit from fidaxomicin treatment. Although further prospective studies are needed, choosing treatment with the goal of preventing recurrent CDI may offer a better guide than disease severity.