1410. The use of a fidaxomicin chaser as effective salvage therapy for vancomycin-refractory, recurrent Clostridium difficile infections
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ID WEEK FID TP ver9.26.13.pdf (113.6 kB)
  • Background: The management of C. difficile infections (CDI) is complicated by high recurrence rates with over 50% of second episodes experiencing a recurrence (RCDI).  Guidelines recommend managing multiple recurrences with a vancomycin taper.  No clear recommendation is available for patients failing this approach.

    Methods: Patients with multiple RCDI that were refractory to vancomycin taper therapy were given either fidaxomicin 200mg BID for 10 days (FID-TX), or a repeat of CDI treatment followed by either a 10-day fidaxomicin regimen as a chaser (FID-CH), or a taper as 200mg daily for 7 days, followed by 200mg QOD for 7-26 days (FID-TP).  Demographic information, CDI history, treatment outcomes, and symptom-free interval (SFI) were collected from patient records. Treatment success was considered if symptoms resolved by the end of therapy and no additional antibiotic was needed.  RCDI was defined by the onset of CDI symptoms following successful treatment for a previous episode.   

    Results: 14 patients received 18 courses of fidaxomicin for RCDI (mean age of 60, mean of 4.6 previous CDI episodes, mean of 2.3 previous vancomycin taper courses).  All 18 courses resulted in treatment success (3 courses as FID-TX, 8 as FID-CH, and 7 as FID-TP).  Of 3 FID-TX courses, there were 2 RCDI episodes (66%).  When excluding RCDI due to antimicrobial exposure, there were 2 RCDI (25%) observed after the 8 FID-CH courses and no RCDI following the 7 FID-TP courses.  The average SFI following a vancomycin taper was 37 days.  The average SFI following FID-TX, FID-CH, and FID-TP was 73, 240, and 150 days, respectively.

    Conclusion: Patients with RCDI that failed multiple vancomycin tapers had symptom resolution following fidaxomicin therapy.  All 3 regimens provided a greater SFI compared to a vancomycin taper. No patient experienced RCDI following FID-TP.  FID-CH had the longest SFI, yet follow-up time with FID-TP was shorter given more recent adoption of this regimen. These results suggest the utility of using fidaxomicin to treat RCDI.

    Melinda Soriano, PharmD, Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, Larry H. Danziger, Pharm.D., University of Illinois at Chicago, Chicago, IL and Stuart Johnson, MD, FIDSA, Edward Hines, Jr. VA Hospital, Hines, IL

    Disclosures:

    M. Soriano, None

    L. H. Danziger, Cubist: Investigator and Speaker's Bureau, Consulting fee and Research grant
    Optimer: Consultant and Speaker's Bureau, Speaker honorarium

    S. Johnson, None

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