Dr. Kevin Garey (@GareyKgarey), Dr. Kelly Reveles (@KellyReveles), Dr. Mandelin Cooper, and host Dr. Rachel Britt (@RachelBPharmD) discuss proposed updates of the IDSA-SHEA C. difficile guidelines, including: fidaxomicin over oral vancomycin as first-line therapy, the roles and logistical hurdles of fecal microbiota transplant, bezlotoxumab, and the pros and cons of prophylaxis.

Timestamps

1:16 - Panel introductions 3:19 - Fidaxomicin vs PO vancomycin for first occurrence 7:21 - Fidaxomicin cost effectiveness 11:26 - Factors to consider for health systems when considering switch to fidaxomicin 14:23 - Fidaxomicin vs PO vancomycin for recurrences 17:52 - Role of pulsed and tapered PO vancomycin 19:57 - Role of fecal microbiota transplant (FMT) 22:24 - Challenges of FMT and where pharmacy fits in 27:27 - Bezlotoxumab 31:54 - Feasibility issues with bezlotoxumab and strategies to address them 35:25 - CDI prophylaxis 40:28 - Stewardship's role in reducing C. difficile infections

References

Fidaxomicin Cost-effectiveness

• Reveles KR, et al. Pharmacotherapy. 2017;37(12):1489-97.
• Watt M, et al. Infection. 2016;44(5):599-606.
• Cornely OA, et al. J Antimicrob Chemother. 2018;73(9):2529-39.
• Rubio-Terres C, et al. Eur J Clin Microbiol Infect Dis. 2019;38(6):1105-11.

Bezlotoxumab

• Wilcox MH, et al. N Engl J Med. 2017;376:305-17.
• Oksi J, et al. Eur J Clin Microbiol Infect Dis. 2019;38(10):1947-52.
• Hengel RL, et al. Open Forum Infect Dis. 2020;7(4):ofaa097.

Bezlotoxumab Cost-effectiveness

• Salavert M, et al. Adv Ther. 2018;35(11):1920-34.
• Prabhu VS, et al. Clin Infect Dis. 2018;66(3):355-62.

Primary prophylaxis 

• Pereiras MA, et al. Biol Blood Marrow Transplant. 2017; 23:S395. 
• Ganetsky A, et al. Clin Infect Dis. 2019;68(12):2003-2009.
• Mullane KM, et al. Clin Infect Dis. 2019; 68(2):196–203.

Secondary prophylaxis  

• Carignan A, et al. Am J Gastroenterol. 2016;111:1834-1840.
• Van Hise NW, et al. Clin Infect Dis. 2016;63:651-653.
• Splinter et al. Ann Pharmacother. 2018;52:113-119.
• Knight EM, et al. J Pharm Pract. 2019;:897190019825994.
• Morrisette T, et al. Biol Blood Marrow Transplant. 2019;25(10):2091-2097.