The use of fidaxomicin for treatment of relapsed Clostridium difficile infections in patients with cancer.

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The use of fidaxomicin for treatment of relapsed Clostridium difficile infections in patients with cancer.

Pharmacotherapy. 2014 Nov;34(11):1220-5

Authors: Esmaily-Fard A, Tverdek FP, Crowther DM, Ghantoji SS, Adachi JA, Chemaly RF

Abstract
OBJECTIVES: To report our experience with the use of fidaxomicin (FDX), an oral macrocyclic antibiotic, in cancer patients with Clostridium difficile infection (CDI).
METHODS: A single-center retrospective case series was conducted at The University of Texas MD Anderson Cancer Center. Patients with CDI treated with FDX from May 2011 to January 2013 were identified via the pharmacy database. Clinical response and recurrence after FDX initiation were evaluated.
RESULTS: Twenty-two patients were included, most of whom were male (55%) with a mean age of 58 years (range: 20-83 yrs). The most common underlying malignancies were nine patients with lymphoma (41%), seven with leukemia (32%), and six with solid tumors (27%). Indications for FDX included recurrent CDI in 16 patients (72%) and failure of both metronidazole and oral vancomycin in 6 patients (28%). Nineteen patients (86%) were on concomitant antimicrobials during CDI treatment. Clinical response to FDX was 91%, and overall sustained clinical response was 82%. FDX was well tolerated with no major adverse events that were FDX related or discontinuations due to drug-related adverse events.
CONCLUSION: In cancer patients, FDX is effective treatment for the first episode of CDI after failure of standard therapies and treatment of recurrent CDI. This was interesting given the large number of high-risk patients who continued to receive concomitant antimicrobial therapy, which is common in this immunocompromised patient population.

PMID: 25164587 [PubMed - indexed for MEDLINE]

One thought on “The use of fidaxomicin for treatment of relapsed Clostridium difficile infections in patients with cancer.

  • John Cras

    on

    I disagree with the authors conclusion that “This was interesting…” Fidaxomicin has already been shown to be more effective than metronidazole or vancomycin for recurrent CDI. I would expect that to apply to immunocompromised patients as well. Furthermore, fecal microbiota transplant has been shown to be just as efficacious (if not more) in immunocompromised patients.

    http://www.nature.com/ajg/journal/v109/n7/full/ajg2014133a.html

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