Dificid (fidaxomicin) / Merck (MSD), Astellas - LARVOL DELTA

CdmR, a MarR family protein from Clostridioides difficile, binds with positive cooperativity in the predicted promoter region of a MATE efflux transporter. (PubMed, Biochem Biophys Rep) - "Of significant concern is the evolving antibiotic resistance of this pathogen, notably the recent emergence of strains with resistance to vancomycin and fidaxomicin, the first-line antibiotics currently used to treat C. difficile infections. The location of these sites strongly suggests that CdmR binding represses its own expression and that of the MATE gene. CdmR exhibits positive binding cooperativity at the two DNA sites, suggesting a highly sensitive and tightly controlled regulatory mechanism that may play an important role in the antibiotic resistance profile of C. difficile."

Journal • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Septic Shock

Clostridioides difficile Infection in Special Populations: Focus on Inflammatory Bowel Disease-A Narrative Review from Pathogenesis to Management. (PubMed, Biomedicines) - "Recommended first-line treatments are fidaxomicin or oral vancomycin, reserving fecal microbiota transplantation for recurrent or high-risk cases. CDI and IBD share a mutual pathogenic interplay in which microbial, immune, and therapeutic factors from each condition drive and magnify the other. Early recognition, guideline-based antibiotic therapy, judicious use of immunosuppression, and microbiota-based preventive strategies are crucial to improve patient outcomes and limit recurrence, thus reducing healthcare costs."

Journal • Review • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Transplantation • Ulcerative Colitis

Recurrent Clostridium difficile Infections in a Patient With Ulcerative Colitis: A Case Report. (PubMed, Cureus) - "Despite treatment with vancomycin, metronidazole, and fidaxomicin in succession, he experienced recurrent episodes of CDI that ultimately progressed to septic shock and death. This case highlights the nature of recurrent CDI in this patient population and the complexity and increased morbidity associated with its management in elderly patients with UC. It underscores the importance of careful evaluation of underlying risk factors, judicious antibiotic use, and consideration of alternative treatment modalities, such as faecal microbiota transplantation (FMT), for the prevention of recurrent CDI."

Journal • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Septic Shock • Transplantation • Ulcerative Colitis

A Tale of Two Infections: A Rare Synchronous Infection of Herpes Simplex Virus Oesophagitis and Clostridium difficile in an Immunocompetent Host. (PubMed, Cureus) - "The stool sample detected toxigenic C. difficile, and a course of fidaxomicin was completed...She was readmitted due to the recurrence of her symptoms. HSV was confirmed, and the patient started on dual antimicrobial therapy with marked improvement and resolution.  This case study prompts us to consider non-traditional risk factors such as immunosenescence, frailty, proton pump inhibitors (PPIs), and nutritional deficiencies in addition to the lack of primary prevention measures."

Journal • Gastrointestinal Disorder • Herpes Simplex • Infectious Disease • Pain

In Vitro Activity of Sulfamethoxazole-Trimethoprim, Amikacin, Oxazolidinones, Fluoroquinolones and Fidaxomicin against Isolates of Nocardia. (PubMed, ACS Omega) - "This study evaluates the in vitro activity of common and potential antimicrobials, including Trimethoprim-sulfamethoxazole, Amikacin, Oxazolidinones (Linezolid, Tedizolid, Contezolid), Fluoroquinolones (Moxifloxacin, Levofloxacin, Sitafloxacin), Rifampicin, and Fidaxomicin against 51 clinical Nocardia isolates. These findings highlight the need for tailored treatment strategies based on species-specific susceptibility and resistance profiles and suggest Fidaxomicin and Sitafloxacin as promising options. Further clinical validation is warranted to optimize therapeutic outcomes."

Journal • Preclinical • Infectious Disease • Nontuberculous Mycobacterial Disease • Pulmonary Disease • Respiratory Diseases • Tuberculosis

Diagnosis and Management of C. difficile. (PubMed, Am J Gastroenterol) - "Treatment paradigms are discussed across the spectrum of disease severity, with vancomycin and fidaxomicin as first-line therapies and the diminishing role of metronidazole. For recurrent CDI, newer fecal microbiota-based therapies, including Fecal Microbiota, live-jslm (Rebyota, RBL) and Fecal Microbiota Spores, live-brpk (Vowst, VOS), are reviewed. The role of conventional fecal microbiota transplantation (FMT), particularly in fulminant CDI, is also addressed, including challenges resulting from FDA policies around stool bank material. We aim to clarify diagnostic and therapeutic approaches and optimize care for patients with CDI."

Journal • Infectious Disease • Transplantation

Effect of sub-minimum inhibitory concentrations of metronidazole, vancomycin, and fidaxomicin on growth rate and virulence of Clostridioides difficile. (PubMed, Diagn Microbiol Infect Dis) - "Notably, FDX uniquely downregulated the surface layer protein gene slpA across both strains. These results show that antibiotic sub-MICs can modulate bacterial virulence, highlighting the need to reassess the impact of antibiotic dosing on C. difficile pathogenesis during treatment."

Journal • Infectious Disease

OpTION: Optimal Treatment for Recurrent Clostridium Difficile (clinicaltrials.gov) - P4 | N=308 | Terminated | Sponsor: VA Office of Research and Development | Completed ➔ Terminated; The study sponsor stopped the trial early after enrolling 308 of the target sample size because of a slower than expected recruitment rate.

Trial termination • Infectious Disease

Rectal Fidaxomicin as Salvage Therapy in Fulminant Clostridioides difficile Infection After Total Colectomy: A Case Report. (PubMed, HCA Healthc J Med) - "The 2021 guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) recommend vancomycin and metronidazole for fulminant CDI (FCDI), with consideration of rectal vancomycin for cases with ileus...Our case study involves a 79-year-old man with worsening symptoms post-amoxicillin/clavulanic acid use...He was eventually started on rectal fidaxomicin and loperamide, resulting in rapid improvement...In summary, this case underscores the complexity of FCDI management and highlights the potential of rectal fidaxomicin as a salvage therapy. Further research is warranted to elucidate its role in treating FCDI and incorporating it into clinical practice guidelines."

Journal • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Septic Shock

Bezlotoxumab As Treatment for Recurrent/Chronic Clostridioides Difficile Infection in Stem Cell Transplant Recipients (ASH 2024) - "However, the safety and efficacy of bezlotuxumab has not been studied in pediatric patients undergoing a SCT, and no data exists to detail its impact on common immunosuppressants such as tacrolimus and mycophenolate mofetil (MMF)...Following relapse of AML, the patient enrolled on a clinical trial to receive a KMT2A inhibitor, revumenib, achieved remission, and eventually proceeded to a second SCT using a single cord donor. The patient's post-SCT course was complicated by Streptococcus mitis/oralisbacteremia, resulting in a long course of broad-spectrum antibiotics with vancomycin and meropenem...At this recurrence, she was hospitalized for dehydration and treated with oral vancomycin, subsequently transitioning to oral fidaxomicin over a 21-day taper...All patients were confirmed to have no gastrointestinal GVHD causing the diarrhea, and no recurrence of diarrhea occurred after bezlotoxumab. This case series strongly suggests the potential utility of bezlotoxumab..."

Clinical • Acute Myelogenous Leukemia • Gastroenterology • Gastrointestinal Disorder • Graft versus Host Disease • Hematological Malignancies • Immunology • Infectious Disease • Leukemia • Oncology • Pediatrics • Pneumonia • Respiratory Diseases • Transplantation • DEK • KMT2A • NUP214

The Ongoing Challenge of Clostridioides Difficile Infection in Austria: Economic Evaluation of Two Recommended Treatment Pathways (ISPOR-EU 2025) - "This economic analysis is a comparison of current clinical practice which is based on reimbursement limitations regarding the Austrian reimbursement codex (EKO) (reference-pathway) versus the new Austrian guideline from the Austrian Society of Gastroenterology and Hepatology (ÖGGH), which recommends use of fidaxomicin (Dificlir®) as first-line therapy (ÖGGH-pathway). A decision-tree model was developed to reflect the CDI treatment-pathway... The ÖGGH guideline is the dominant strategy, providing improved health outcomes at lower costs, and represents a cost-effective option for CDI management in Austria."

HEOR • Hepatology • Infectious Disease

Consumption and expenditure on fidaxomicin and oral vancomycin for Clostridioides difficile infection: a 12-year longitudinal study of 43 countries and regions. (PubMed, Int J Antimicrob Agents) - "Consumption of fidaxomicin and oral vancomycin continues to increase globally; however, significant economic and geographical disparities in utilisation highlight inequitable access to first-line CDI treatments."

Journal • Observational data • Infectious Disease

Assessing 30-day recurrence for patients testing indeterminate for Clostridioides difficile based on treatment status. (PubMed, Anaerobe) - "This single-center retrospective cohort study aims to assess recurrence of CDI in treated versus not treated adults producing indeterminate tests. We assessed 121 treated versus 49 not treated patients, finding no difference in recurrence."

Journal • Infectious Disease

Use of Fidaxomicin Compared to Vancomycin for Decolonization of C. Difficile in Patients With Inflammatory Bowel Disease (clinicaltrials.gov) - P4 | N=60 | Not yet recruiting | Sponsor: Brigham and Women's Hospital | Initiation date: Sep 2025 ➔ Sep 2026

Trial initiation date • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease

Beyond the Gut: C. diff Bacteremia in an Elderly Patient (ACG 2025) - "Imaging was significant for a large peripherally enhancing collection with air colliculi in the right abdomen, concerning for an abscess and patient was started on piperacillin tazobactam. Patient was also started on rectal vancomycin for c diff colitis which was later transitioned to oral fidaxomicin when the blood cultures became positive for c difficile...Management should be individualized, and multidisciplinary involvement is strongly advised. Figure: Abdominal abscess on imaging"

Clinical • Atrial Fibrillation • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Pneumonia • Respiratory Diseases

Clostridioides difficile-Induced Disseminated Intravascular Coagulation in a Patient With ESRD: A Fatal Case Report (ACG 2025) - "Initial imaging showed colitis, and empiric antibiotics (cefepime and vancomycin) were started...Antibiotics were escalated to fidaxomicin and eravacycline...Atypical presentations without initial diarrhea and complicating factors such as anticoagulation can obscure diagnosis. Clinicians should maintain vigilance for systemic manifestations like DIC, even in the absence of bowel necrosis, particularly in high-risk populations such as those with ESRD."

Case report • Clinical • Anemia • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Renal Disease • Respiratory Diseases • Type 2 Diabetes Mellitus

Empyema Unmasked: A Cirrhotic Tale With a C. diff Twist (ACG 2025) - "He was diagnosed with SBEM and treated with IV ceftriaxone, transitioned to oral ciprofloxacin for outpatient prophylaxis...These were treated with vancomycin or fidaxomicin, and ultimately resolved after fecal microbiota transplant...Treatment of SBEM is the same as SBP, typically with a 3rd-generation cephalosporin, as well as furosemide and spironolactone when feasible...Unfortunately this may have led to the development of C diff colitis. This case highlights an interesting presentation of cirrhosis in an undiagnosed patient as well as the potential consequences that prophylactic antibiotics may carry.Figure: Figure 1"

CNS Disorders • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Pneumonia • Pulmonary Disease • Respiratory Diseases • ALK

Pseudomembranous Colitis With Underlying Inflammatory Bowel Disease in a Toxin-Negative Case (ACG 2025) - "A prolonged treatment course with vancomycin for 14 days reduces recurrence likelihood in IBD patients versus a standard 10-day course¹. Fidaxomicin is also likely effective despite limited evidence. FMT within 2-4 days is advised to prevent CDI recurrences and restore gut microbiome in IBD¹. Understanding testing and treatment discrepancies in IBD-related CDI is crucial to prevent complications and optimize outcomes."

Clinical • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Mucositis • Nephrology • Renal Calculi • Ulcerative Colitis

Fidaxomicin Treatment for Clostridioides difficile Infection in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis (ACG 2025) - "Five studies met inclusion criteria, comprising a total of 4,205 patients with IBD and CDI treated with fidaxomicin. Meta-analysis showed a pooled CDI recurrence of 10.97% (95% CI: 9.32–12.73%), mortality of 6.68% (95% CI: 1.81–13.96%), and colectomy rate of 1.57% (95% CI: 1.17–2.02%). Comparative analysis found no significant differences between fidaxomicin and vancomycin in recurrence, mortality, or colectomy."

Retrospective data • Review • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease

Comparing the Recurrence Rate of Clostridioides difficile Infection (CDI) in Patients With Inflammatory Bowel Disease After Low, Medium, and High Dose Oral Vancomycin After the First Episode of CDI (ACG 2025) - "Introduction: Oral vancomycin (OV) is commonly used for an initial Clostridioides difficile infection (CDI) episode in patients (pts) with inflammatory bowel disease (IBD). 273 IBD pts (CD, n=123 pts [45.1%]; UC, n=150 pts [54.9%]) with a CDI diagnosis treated with OV, were identified. Of these pts, 38 (13.9%) had a diagnosis of rCDI. Even though the rates of rCDI were not statistically significant in UC pts versus CD patients, there was a trend towards slightly higher rCDI in the UC cohort (14.6% versus 13%, p=0.83)."

Clinical • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease

Severe Colitis Mimicking Inflammatory Bowel Disease: A Rare Case of Cholestyramine-Related Granulomatous Injury (ACG 2025) - "Her symptoms persisted despite oral vancomycin, fidaxomicin, IV piperacillin-tazobactam, and IV steroids. Diagnosis may require confirmation by histology, especially when endoscopic findings are non-specific. Early suspicion can present unnecessary steroid and antibiotic use as well as surgical morbidity."

Clinical • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Inflammation • Inflammatory Bowel Disease

A National Database Analysis (1999–2022) (ACG 2025) - "Treatment advances include the FDA-approved antibiotic fidaxomicin (2011), which is more effective than vancomycin for reducing recurrence, especially in recurrent cases. From 1999–2022, enterocolitis due to Clostridium difficile caused 116,979 deaths, with an overall age-adjusted mortality rate (AAMR) of 1.51. Mortality rose from 0.28 in 1999, peaked at 2.36 in 2008, then declined to 0.98 in 2020, stabilizing around 1.00 in 2021–2022. The >65 years age group had the highest mortality, increasing from 2.15 in 1999 to 17.46 in 2011, then declining to 6.67 in 2022."

Gastrointestinal Disorder • Infectious Disease

Clostridioides difficile Enteritis: A Systematic Review of Case Reports (ACG 2025) - "The initial search yielded 2,120 articles, which were filtered using study design, English language, and human subjects. After screening for duplicates and excluding irrelevant articles, 40 articles comprising 44 patients were included in the final review. Of the 44 individual cases reviewed, 22 (50%) were male and 22 (50%) were female."

Case report • Clinical • Review • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation

Methotrexate-Induced Decompensated Liver Cirrhosis: A Case Report (ACG 2025) - "She was initially treated for suspected C. difficile infection with antibiotics & fidaxomicin...The patient was started on diuretics (spironolactone and furosemide), resulting in partial improvement of ascites...Liver function tests and imaging should be performed periodically to detect early signs of hepatic dysfunction. Methotrexate cessation should be considered in patients with progressive liver damage to prevent irreversible fibrosis as they are at high risk due to dysregulation of innate immunity and increased pro-inflammatory cytokine production.Figure: CT scan Abdomen showing liver cirrhosis and ascites"

Case report • Clinical • Cardiovascular • Fibrosis • Gastroenterology • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Liver Cirrhosis • Liver Failure • Metabolic Dysfunction-Associated Steatotic Liver Disease • Nephrology • Renal Disease • Rheumatoid Arthritis • Rheumatology • Thrombosis

Protein-Losing Enteropathy With Severe Hypoalbuminemia Associated With Fulminant Clostridiodes Difficile Colitis: A Case Report (ACG 2025) - "She was treated with vancomycin and metronidazole, then fidaxomicin. While FMT is a potential treatment for CDI, the fulminant course and rapid deterioration did not allow for this intervention. This case underscores the importance of judicious antibiotic use, early recognition of PLE in CDI patients, and the need for aggressive disease management, especially in elderly patients.Figure: A graph showing the trend of serum albumin levels during hospitalization"

Case report • Clinical • Acute Kidney Injury • Anemia • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Hematological Disorders • Hypotension • Immunology • Infectious Disease • Metabolic Disorders • Renal Disease • Respiratory Diseases