No abstract

Patients with CDI given a rifaximin chaser regimen experienced a decreased incidence of recurrent diarrhoea compared with placebo.

Clostridium difficile infection (CDI) is the most common cause of identifiable diarrhea in hospitalized patients. The incidence and severity of CDIs are increasing. The increased incidence and severity of the disease has sparked interest in the optimal treatment of CDI as well as the use of new therapies and drug discovery. Current treatment strategies are inadequate with decreased response rates to metronidazole, and high recurrence rates with the use of metronidazole and oral vancomycin. Although incidence rates continue to be low, in vitro resistance to antibiotics used for the treatment of CDI has been noted. Recently, important data has emerged on new anti-C. difficile antibiotics such as rifaximin, rifalazil, fidaxomicin, nitazoxanide, tigecycline and ramoplanin. The purpose of this review is to provide an update on the in vitro susceptibility and new antibiotic treatment options for CDI. This review will focus primarily on scientific studies published in the last 36 months in order to provide an up-to-date review on the topic. KeywordsClostridium difficile; fidaxomicin; nitazoxanide; rifaximin; treatment update Clostridium difficile infection (CDI) is the most common cause of identifiable diarrhea in hospital ized patients. CDI is an evolving pathogen with high incidence and severity. Current treatment of CDI is evolving and a number of new antibiotic treatment options are available [1][2][3]. In vitro resistance to antibiotics used for the treatment of CDI continues to be low; however, resistance among certain strains has been identified. Recently, important data has emerged on new anti-C. difficile antibiotics such as rifaximin, rifalazil, fidaxomicin, nitazoxanide, tigecycline and ramoplanin. The purpose of this review is to provide an update on the in vitro susceptibility and new treatment options for CDI. The present article will focus on scientific studies published primarily in the last 36 months in order to provide an up-to-date review on the topic. With CDI and drugs that concentrate in the gut, the concept of using antimicrobial breakpoints for resistance or susceptibility based on systemic drug concentrations may be inadequate [22]. More studies are needed to determine a physiologic breakpoint for enteric infectious diseases considering drug pharmacokinetics and pharmacodynamics. Colonic concentrations of active antibiotics should be related to the MIC of the organism in order to generate appropriate breakpoints for nonsystemic infections. Update on treatment of CDI with metronidazole & oral vancomycinA summary of randomized controlled trials with metronidazole or oral vancomycin compared with new or emerging therapies is presented in 15,000 cells/mm 3 . The cure rate was similar for patients given metronidazole (90%; n = 41) and oral vancomycin (98%; n = 40) for mild CDI. There was a significantly higher cure rate for severe patients treated with oral vancomycin (97%; n = 31) than metronidazole (76%; n = 38; p = 0.02). These results were similar to a Phase III comparator trial of tolev...

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