Journal of Infectious Diseases & Therapy
Open Access

Abstract

Introduction: National and international treatment guidelines endorse fidaxomicin (macrocylic antibiotic) for severe and
recurrent Clostridium difficile infection (CDI). Reports of ‘real world’ practise are rare and inconsistent with clinical trials.
We describe our inpatient CDI experience of fidaxomicin.
Method: Inpatients (aged >18) experiencing diarrhoea and positive C.difficile stool toxin enzyme immunoassay, prescribed
fidaxomicin between September 2012-September 2014, were identified from Hospital databases. Medical records were
retrieved. Public Health England criteria defined first/recurrent episodes, healthcare/community associated cases, severity and
response.
Results: Fourteen patients, representing 11.6% of hospitalised CDI cases, received fidaxomicin. Notes were retrieved in
13/14 (92.9%) patients. Median age was 83 (IQR 81-87), most were female [11/13 (84.6%)], first episodes [9/13(69.2%)]
and indeterminate or community associated [8/13 (61.5%)]. Ten ribotypes were isolated, 002 [3/13 (23.1%)] most frequent.
None were ribotype 027. Most [10/13 (76.9%)] were non-severe CDI at fidaxomicin onset, median time to initiation 14 (IQR
4-25) days. One (7.7%) received fidaxomicin first line (recurrent CDI). Previous therapy included combined vancomycin and
metronidazole, 7/13 (53.8%) cases, 4 (30.8%) vancomycin and one (7.7%) metronidazole alone. Two (15.4%) patients received
rifampicin and one (7.7%) immunoglobulin. All patients were subject to multidisciplinary team (MDT) review. Ten (76.9%)
responded; no relapses or CDI related readmissions were recorded within six months. Median time to symptom improvement
was 4 (IQR 2-7) days. Overall in-hospital mortality was 7.7%.
Conclusion: Our ‘real life’ experience is favourable with no recurrences and readmissions. Further evaluation of fidaxomicin
in clinical practise is required as is the MDT role in decision making.

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