Reviewed by Jen Cihlar, DO, Vanderbilt University Medical Center
Bottom line: In a hypothesis-generating study,5-7 days versus 10 days for treatment of C diff with oral vancomycin or fidaxomicin might have similar clinical efficacy and rates of recurrence, however more investigation is required.
In ongoing efforts to study shorter effective antibiotic durations, between January 2022 and May 2023 Duricek et al compared effectiveness and risk of recurrence between 10 days vs 5-7 days of oral vancomycin or fidaxomicin, which is consistent with their clinical guidelines that recommend shorter durations among patients clinically improving. They found no statistical difference in the two groups regarding recurrent CDI at 2 month follow up (study group 2/25 vs control group 5/22; p=0.24), nor measured lab parameters WBC and CRP. This study is limited by small sample size, single center, with majority of patients being treated for first episode of CDI. With this observational study design, the treatment group with shortened duration was selected based on patients who had “good clinical” and lab responses at 5-7 days which suggests the possibility of confounding by indication. It should be noted that some of the patients in each arm had GDH positive, toxin negative and no additional confirmatory NAAT testing, which could also skew results.
Reference: M Duricek, K Halmova, M Krutova, B Sykorova, J Benes, Is shorter also better in the treatment of Clostridioides difficile infection?, Journal of Antimicrobial Chemotherapy, Volume 79, Issue 6, June 2024, Pages 1413–1417, https://doi.org/10.1093/jac/dkae119