No antibiotic has proven to be consistently superior as a first-shot cure for Clostridium difficile infection, although the recently approved macrocyclic agent fidaxomicin (Dificid) was associated with fewer recurrences, a systematic review showed.
In three studies of the two most commonly compared agents, there were no differences in initial cure rates for vancomycin and metronidazole, with disease resolution rates ranging from 84% to 94% and 73% to 94%, respectively, according to Dimitri M. Drekonja, MD, of the Minneapolis Veterans Affairs Health Care System, and colleagues.
But in one study, recurrence was less common among patients treated with fidaxomicin than among those given vancomycin, with rates of 15% and 25%, respectively (−10 percentage point difference, 95% CI −17 to −3, P=0.005), the authors reported in Annals of Internal Medicine.