Q: What advantage fidaxomicin has over oral vancomycin or metronidazole in treatment of C. difficile infection?


Answer: Fidaxomicin has a narrower antimicrobial spectrum than other antibiotics for treatment of clostridium difficile colitis which leads to less disruption of the normal colonic anaerobic microflora. Though cure rate remained same but recurrence rate is significantly lower, and that is why it is used as a reserve for patients with recurrent C. difficile infection.



References: 

Venugopal AA, Johnson S. Fidaxomicin: a novel macrocyclic antibiotic approved for treatment of Clostridium difficile infection. Clin Infect Dis 2012; 54:568. 

Cornely OA, Nathwani D, Ivanescu C, et al. Clinical efficacy of fidaxomicin compared with vancomycin and metronidazole in Clostridium difficile infections: a meta-analysis and indirect treatment comparison. J Antimicrob Chemother 2014; 69:2892. 

Eyre DW, Babakhani F, Griffiths D, et al. Whole-genome sequencing demonstrates that fidaxomicin is superior to vancomycin for preventing reinfection and relapse of infection with Clostridium difficile. J Infect Dis 2014; 209:1446.