Clinical Medicine Insights: Therapeutics

Fidaxomicin is a bactericidal macrolide that is indicated for the treatment of Clostridium difficile infection (CDI) in adults. Fidaxomicin is not effective for the treatment of systemic infections due to minimal systemic absorption. Until recently, oral vancomycin was the only medication with United States Food and Drug Administration (FDA) approval for the treatment of CDI. In clinical studies, fidaxomicin demonstrated noninferiority to vancomycin for the treatment of CDI. Lower recurrence rates of CDI with fidaxomicin than with oral vancomycin were observed. The lower recurrence rates were not observed with highly virulent strains of C. difficile. Lower recurrence rates of CDI with fidaxomicin are believed to be associated with its narrow spectrum of activity. Fidaxomicin was approved for use after publication of the most recent guideline from the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA). However, its current place in clinical practice is unknown. The cost of fidaxomicin should be considered when prescribing this medication.