Treatment Strategies for Recurrent Clostridium difficile Infection

Leong, Christine; Zelenitsky, Sheryl

doi:10.4212/cjhp.v66i6.1301

Cited by 23 publications

(24 citation statements)

References 52 publications

(115 reference statements)

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“…Some studies support the use of intravenous immunoglobulin, probiotics, cholestyramine, or fidaxomicin in RCDI, though the evidence is deemed marginal. [5][6][7][8][9]37 Economically dominant interventions, such as FMT versus vancomycin, are relatively uncommon in health care. Therefore, finding an intervention that is clinically effective and also cost saving supports its implementation as a potential first line modality.…”

Section: Discussionmentioning

confidence: 99%

“…Vancomycin is expensive and has a high rate of RCDI regardless of the dose, duration, or regimen (eg, pulse or tapered) prescribed. [5][6][7][8][9] Recently proposed guidelines from the American College of Gastroenterology (ACG) and American Gastroenterology Association (AGA) include fecal microbiota transplantation (FMT) as a therapeutic option for RCDI at or after the third recurrence. 5,10 FMT consists of transplanting a fecal suspension from a healthy donor into the RCDI patient's gastrointestinal tract.…”

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confidence: 99%

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Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Varier

Biltaji

Smith

et al. 2015

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Varier

Biltaji

Smith

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…Vancomycin is expensive and has a high rate of RCDI regardless of the dose, duration or regimen (e.g. pulse or tapered) prescribed [5,[10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection

Varier

Biltaji

Smith

et al. 2014

Clinical Microbiology and Infection

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Clostridium difficile infection (CDI) is costly. Current guidelines recommend metronidazole as first-line therapy and vancomycin as an alternative. Recurrence is common. Faecal microbiota transplantation (FMT) is an effective therapy for recurrent CDI (RCDI). This study explores the cost-effectiveness of FMT, vancomycin and metronidazole for initial CDI. We constructed a decision-analytic computer simulation using inputs from published literature to compare FMT with a 10-14-day course of oral metronidazole or vancomycin for initial CDI. Parameters included cure rates (baseline value (range)) for metronidazole (80% (65-85%)), vancomycin (90% (88-92%)) and FMT(91% (83-100%)). Direct costs of metronidazole, vancomycin and FMT, adjusted to 2011 dollars, were $57 ($43-72), $1347 ($1195-1499) and $1086 ($815-1358), respectively. Our effectiveness measure was quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were conducted from the third-party payer perspective. Analysis using baseline values showed that FMT($1669, 0.242 QALYs) dominated (i.e. was less costly and more effective) vancomycin ($1890, 0.241 QALYs). FMT was more costly and more effective than metronidazole ($1167, 0.238 QALYs), yielding an incremental cost-effectiveness ratio (ICER) of $124 964/QALY. One-way sensitivity analyses showed that metronidazole dominated both strategies if its probability of cure were >90%; FMT dominated if it cost <$584. In a probabilistic sensitivity analysis at a willingness-to-pay threshold of $100 000/QALY, metronidazole was favoured in 55% of model iterations; FMT was favoured in 38%. Metronidazole, as the first-line treatment for CDIs, is less costly. FMT and vancomycin are more effective. However, FMT is less likely to be economically favourable, and vancomycin is unlikely to be favourable as first-line therapy when compared with FMT.

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“…A novel theory to combat recurrences uses colonization resistance by introducing healthy bacteria into the gut to restore the normal flora and prevent C. difficile from obtaining essential nutrients and surviving (Leong & Zelenitsky, 2013). This theory has led us to experimental treatments such as probiotics and fecal microbial transplant (FMT), in which feces of a healthy donor are implanted into the gastrointestinal tract of the diseased patient via oral, nasal, or rectal routes.…”

Section: Introductionmentioning

confidence: 99%

“…Clostridium difficile infections (CDI) are a major burden to the U.S. health system, accruing costs of about 3.2 billion dollars every year and is associated with a high rate of morbidity and mortality, resulting in possible bowel perforation, sepsis, or death (Surawicz, Brandt & Binion, 2013;Leong & Zelenitsky, 2013). Risk factors for the disease include recent antibiotic use, proton-pump inhibitors or other acid-suppressive therapies, advanced age, and immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Literature Review of Saccharomyces boulardii in the Treatment of Refractory Recurrent Clostridium difficile Infection

Warila

Hoover

2017

IJFAAS

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To review the literature surrounding the efficacy of S. boulardii for the treatment of recurrent C. difficile infections. Eligible articles included S. boulardii in patients with recurrent C. difficile infection. The primary endpoint examined was clinical resolution of infection with no further recurrences during followup. Results: Six studies met inclusion criteria. A case report showed resolution of recurrences in one patient, and an experimental trial showed a trend towards decreased recurrences in patients receiving S. boulardii (85% no further recurrences). Two randomized controlled trials found a significant decrease in recurrences for S. boulardii versus placebo (34.6% vs 64.7%, P=0.04; 16.7% vs 50%, P=0.05). One metaanalysis determined significant efficacy for S. boulardii in reducing relapses (RR 0.59, 95% CI 0.35-0.98), while another concluded there was insufficient evidence to recommend probiotics for C. difficile infection. S. boulardii may be considered adjunctively for patients with recurrent C. difficile infection who are refractory to antibiotic regimens alone).

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Treatment Strategies for Recurrent Clostridium difficile Infection

Abstract: Background: Recurrent Clostridium difficile infection represents a major clinical challenge. Treatment is often based on empiric selection from relatively few options supported by limited clinical evidence.

Cited by 23 publications

References 52 publications

Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection

Literature Review of Saccharomyces boulardii in the Treatment of Refractory Recurrent Clostridium difficile Infection

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