Cornely, Oliver A., Nathwani, Dilip, Ivanescu, Cristina, Odufowora-Sita, Olatunji, Retsa, Peny and Odeyemi, Isaac A. O. (2014). Clinical efficacy of fidaxomicin compared with vancomycin and metronidazole in Clostridium difficile infections: a meta-analysis and indirect treatment comparison. J. Antimicrob. Chemother., 69 (11). S. 2892 - 2901. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2091

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Abstract

To evaluate the efficacy of fidaxomicin treatment, which has a limited effect on the normal gut flora, compared with vancomycin and metronidazole treatment in Clostridium difficile infections (CDIs). A systematic literature review was conducted in July to August 2011 and updated in July 2013. For fidaxomicin versus vancomycin, efficacy was evaluated using meta-analysis of data from two Phase III direct comparative studies (naEuroS=aEuroS1164). As there were no studies comparing fidaxomicin and metronidazole, an indirect comparison was made using data from three vancomycin versus metronidazole studies (naEuroS=aEuroS345), using the methodology of Bucher et al. (J Clin Epidemiol 1997; 50: 683-91). This provides an OR for the indirect comparison of fidaxomicin versus metronidazole when direct evidence of fidaxomicin versus vancomycin and vancomycin versus metronidazole is available. Clinical cure rates were similar for fidaxomicin and vancomycin; the OR (95% CI) was 1.17 (0.82, 1.66). Recurrence [0.47 (0.34, 0.65)] was significantly lower and sustained cure rates [1.75 (1.35, 2.27)] significantly higher for fidaxomicin than vancomycin. Similar results were obtained in patient subgroups with severe CDI and with non-severe CDI. From the indirect comparison, the likelihood of recurrence [0.42 (0.18, 0.96)] and sustained cure [2.55 (1.44, 4.51)] were significantly improved for fidaxomicin versus metronidazole. Again, similar results were obtained in those with severe and non-severe CDI. Fidaxomicin provides improved sustained cure rates in patients with CDI compared with vancomycin. An indirect comparison indicates that the same is also true for fidaxomicin versus metronidazole. In view of these data, fidaxomicin may be considered as first-line therapy for CDI.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Cornely, Oliver A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nathwani, DilipUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ivanescu, CristinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Odufowora-Sita, OlatunjiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Retsa, PenyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Odeyemi, Isaac A. O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-424671
DOI: 10.1093/jac/dku261
Journal or Publication Title: J. Antimicrob. Chemother.
Volume: 69
Number: 11
Page Range: S. 2892 - 2901
Date: 2014
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1460-2091
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RANDOMIZED CONTROLLED-TRIALS; IN-VITRO ACTIVITIES; HYPERVIRULENT STRAIN; TREATMENT FAILURE; 1ST REPORT; DIARRHEA; DISEASE; OPT-80; MORTALITY; COLITISMultiple languages
Infectious Diseases; Microbiology; Pharmacology & PharmacyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/42467

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