St. Louis-based Washington University School of Medicine researchers found that fidaxomicin, a treatment for Clostridioides difficile infection, has increased in use but "remains underutilized."
The study, published Sept. 30 in Open Forum Infectious Diseases, analyzed 45,049 patient records from 779 hospitals of adults who received treatment for C. diff infections before and after 2021. In 2021, the Infectious Diseases Society of America recommended fidaxomicin as the only first-line agent for CDI, with vancomycin as an alternative option. Previously, vancomycin and metronidazole had been the recommended first-line agents.
The study found an increased use of fidaxomicin from 5.9% in January 2020 to June 2021 to 13.7% between October 2021 to September 2022. In the same time period, use of vancomycin declined from 87.9% to 82.9%, and metronidazole use decreased from 21.6% to 17.2%.
The Northeast had the smallest increase of fidaxomicin use while the South had the highest.
"While fidaxomicin use for CDI increased (and more than doubled) since the publication of the updated IDSA guidelines, it remained low relative to vancomycin and metronidazole use," the study authors wrote. "These novel findings imply that a substantial number of patients could have received the benefits of fidaxomicin if more hospitals had followed the ISDA 2021 guidelines."
Fidoxomicin is associated with lower C. diff infection recurrences and higher sustained clinical response.