Stewardship / Resistance Scan for Dec 20, 2017

Long-term FMT success
Antibiotic choice for C diff

Study finds long-term success for fecal transplant to treat C difficile

A study yesterday in Clinical Infectious Diseases reports high long-term success rates of fecal microbiota transplant (FMT) against recurrent Clostridium difficile infection (CDI).

Emory University researchers contacted all eligible patients who received FMT for recurrent CDI from Jul 1, 2012, to Dec 31, 2016. Of 190 eligible patients, 137 (72%) completed the telephone survey.

The survey found that 113 of 137 patients (82%) had no C difficile recurrence after a median follow-up of 22 months. Almost all patients (122 of 128, or 95%) said they would undergo FMT again, and 70% of those 122 said they would prefer FMT to antibiotics as initial treatment if they were to have a CDI recurrence.
Dec 19 Clin Infect Dis study


Pulsed-dose fidaxomicin determined superior to vancomycin for C diff

A multicenter European study has found extended pulsed dosing of fidaxomicin to be superior to standard-dose vancomycin for the sustained cure of CDI, according the a report yesterday in The Lancet Infectious Diseases.

In the trial, known by the acronym EXTEND, researchers enrolled 364 patients from 96 European hospitals, half of whom received extended-pulse fidaxomicin (200-milligram [mg] oral tablets twice daily for 5 days, then once every other day on days 7 through 25) and half of whom were prescribed vancomycin (125-mg oral capsules four times daily for 10 days).

In the fidaxomicin group, 124 of 177 patients (70%) were still cured 30 days after their treatment ended, compared with 106 of 179 patients (59%) who received vancomycin. The rate of adverse events did not differ between the two groups.

In a commentary on the study in the same issue, US medical researcher Dale N. Gerding, MD, said the study holds promise but requires "more sophistication" in its application. He says the exact dosing of fidaxomicin for CDI still needs fine-tuning, and its cost is steep. In addition, he writes, "Adjunctive measures such as monoclonal antibodies and faecal microbiota transplants are also available to reduce the incidence of recurrent C difficile infection."

The study was funded by Astellas Pharma, Inc, of Japan, which is licensed to develop and market fidaxomicin in various parts of the world, including Europe.
Dec 19 Lancet Infect Dis study
Dec 19 Lancet Infect Dis

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