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

Current practices and unmet needs in the management of Clostridioides difficile infection in pediatric inflammatory bowel disease: A national survey. (PubMed, J Pediatr Gastroenterol Nutr) - "This nationwide survey highlights substantial unmet needs in CDI management in pediatric IBD, including variability in diagnostic strategies, lack of consensus on first-line therapy, and uncertainty regarding immunosuppressive management, supporting the need for evidence-based pediatric-specific guidelines."

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

Ulcerative Rectosigmoid Langerhans Cell Histiocytosis Mimicking Late-Onset Inflammatory Bowel Disease (ACG 2026) - "She had a history of indeterminate colitis diagnosed in 2023 with patchy colonic and small bowel involvement requiring multiple targeted immune modulating (TIM) therapies including vedolizumab, Risankizumab, infliximab, adalimumab, and azathioprine...On admission, she was found to have a Clostridium difficile infection and was started on fidaxomicin with clinical response...The patient was re-started on targeted LCH therapy with dabrafenib by hematology and nutritional support via total parenteral nutrition...B: On higher magnification, the lamina propria contains patchy histiocytic infiltrates, which are accompanied by scattered eosinophils and are in close association with colonic crypts with crypt injury, cryptitis and crypt abscesses (hematoxylin-eosin stains at 200x). C: CD1a immunohistochemistry is strongly and diffusely positive in the histiocytic infiltrates, supporting the diagnosis of Langerhans cell histiocytosis (CD1a stain, 200x)."

CNS Disorders • Endocrine Disorders • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hematological Malignancies • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Langerhans Cell Histiocytosis • CD1a

Looking Beyond Clostridioides Difficile: Persistent Diarrhea Unmasking PembrolizumabâInduced ImmuneâMediated Colitis (ACG 2026) - "She continued to have 5â7 loose bowel movements daily and crampy abdominal pain despite oral vancomycin and a switch to fidaxomicin after 5 days...Disease was refractory to corticosteroids and infliximab but ultimately responded to upadacitinib...Figure: Figure 2. Gross bloody diarrheal stool and representative colonoscopic images from the ascending, descending, and sigmoid colon demonstrating diffuse erythema, friability, and ulceration, consistent with severe pancolitis due to immuneâmediated colitis in the setting of pembrolizumab therapy."

Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Lung Cancer • Solid Tumor

Could Less Be More? Reconsidering Immunosuppressive Escalation in Refractory Immune Effector Cell-Associated Enterocolitis Complicated by Recurrent C. difficile Infection (ACG 2026) - "Case Description/ A 73-year-old male with multiple myeloma (MM) refractory to several lines of therapy underwent CAR-T infusion with ciltacabtagene autoleucel, developing biopsy-proven disease progression with infiltrative extramedullary disease of the GI tract...difficile PCR returned positive with negative toxin, creating diagnostic uncertainty in the setting of suspected IEC-AE; fidaxomicin was initiated...Diarrhea worsened despite two doses each of cyclophosphamide and vedolizumab...Concurrently, vancomycin was initiated for repeat C. difficile infection and valganciclovir for cytomegalovirus viremia. Ruxolitinib was given for refractory IEC-AE alongside fludarabine for the recurrent and progressive MM involving the GI tract...(A) Upper endoscopy demonstrating diffuse nodular mucosa involving the duodenal bulb and 1st and 2nd portions of the duodenum. (B) Colonoscopy showing grossly normal ascending, transverse, and descending colon despite biopsy-confirmed IEC-AE."

Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Infectious Disease • Inflammatory Bowel Disease • Multiple Myeloma

Outcomes of Clostridioides difficile Infection in Patients Treated With a Partial Versus Complete Course of Fidaxomicin. (PubMed, J Pharm Technol) - "Small sample size limited the ability to detect statistically significant differences in these findings. Larger comparative effectiveness studies are needed."

Journal • Infectious Disease

Management of Clostridioides difficile infections in patients with hematological malignancies - a survey by European Conference on Infections in Leukemia (ECIL) and Infectious Diseases Working Party (IDWP) of The European Society for Blood and Marrow Transplantation (EBMT). (PubMed, Int J Infect Dis) - "The survey identified discrepancies in current practice and highlighted several unmet needs, including better-defined severity criteria, optimization of the use and duration of available agents, and access to intravenous agents for patients unable to take oral therapy."

Journal • Hematological Disorders • Hematological Malignancies • Infectious Disease • Leukemia • Oncology • Transplantation

'Extended-pulsed fidaxomicin versus conventional dosing in patients at high risk of recurrence of Clostridioides difficile infection' - Author's reply. (PubMed, Clin Microbiol Infect) - No abstract available

Journal • Infectious Disease

Clostridioides difficile infection risk and contemporary antibiotic use: Evidence from a large real-world dataset highlighting the need for a comprehensive antibiotic stewardship in dentistry. (PubMed, J Dent Sci) - "To isolate a distinct patient group, individuals who had received standard CDI treatments vancomycin, metronidazole, or fidaxomicin either before or after diagnosis were excluded. Notably, historically high-risk antibiotics like clindamycin and fluoroquinolones were not the most frequently used prior to CDI diagnosis. These insights underscore the importance of comprehensive antibiotic stewardship across all classes prescribed in dental care."

Journal • Real-world evidence • Gastroenterology • Gastrointestinal Disorder • Infectious Disease

Comparative Outcomes of Fidaxomicin Versus Vancomycin for Clostridioides difficile Infection: A Propensity-Matched Real-World Analysis (ACG 2026) - "After propensity matching, 4,852 patients were included in each cohort. Fidaxomicin use was associated with significantly lower all-cause mortality compared with vancomycin (8.8% vs 11.0%; HR 0.84, 95% CI 0.74â0.96; p=0.007) and reduced incidence of AKI (11.6% vs 16.7%; HR 0.70, 95% CI 0.63â0.78; p< 0.001). Rates of colectomy and toxic megacolon were low and did not differ significantly between groups."

Clinical • Real-world • Real-world evidence • Acute Kidney Injury • Infectious Disease • Nephrology • Renal Disease

Microbiome Restoration in Fulminant Clostridioides difficile Infection: A Case Series of Fecal Microbiota, Live-jslm for Refractory Disease (ACG 2026) - "He improved with oral vancomycin and intravenous metronidazole but deteriorated after transition to fidaxomicin, with worsening abdominal pain, leukocytosis, and imaging concerning for evolving toxic megacolon. The American Gastroenterology Association suggests microbiome restoration in select individuals not responding to guideline directed medical therapy given associated mortality. Prospective studies are needed to define patient selection, timing of standardized microbiome therapies, and long-term outcomes."

Clinical • Acute Kidney Injury • Gastrointestinal Disorder • Infectious Disease • Nephrology • Renal Disease

The Colitis Conundrum: Triple Pattern Severe Pancolitis With Discordant Infectious and Eosinophilic Features (ACG 2026) - "He was treated with fidaxomicin and high-dose oral vancomycin, along with octreotide, cholestyramine, dietary modification, and supportive care. Finally, this case underscores a practical treatment gap: lack of FMT availability necessitated prolonged high-dose antimicrobial therapy, with potential impact on recovery and resource use. Figure: Colonoscopy findings"

Discordant • Cardiovascular • Chronic Kidney Disease • Diabetes • Dyslipidemia • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hypertension • Hypotension • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Renal Disease • Septic Shock • Type 2 Diabetes Mellitus

Delayed Initiation of Intravenous Corticosteroids in Acute Severe Ulcerative Colitis With Clostridioides Difficile Infection Is Associated With Increased Risk of Colectomy (ACG 2026) - "CDI diagnosis required relevant ICD-10-CM code and/or positive stool test plus prescription of vancomycin or fidaxomicin within 48 hours from emergency department presentation. Among 5,780 patients with ASUC, 1,439 (24.8%) patients had CDI. 315 (21.8%) started IVCS after diagnosis of CDI (Mean age 49.3 +/- 20.7, 44.7% male sex, mean CRP 33.6 +/- 48.2, mean fecal calprotectin 946, mean albumin 3.6 +/- 0.7). After PSM, late ASUC-CDI cohort was associated with significantly higher risk of 14-day colectomy (11.8% vs."

Acute Kidney Injury • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Bowel Disease • Nephrology • Renal Disease • Ulcerative Colitis

Bezlotoxumab: A Key Deterrent for Recurrent Hypervirulent Clostridioides difficile (ACG 2026) - "We present a case of recurrent CD requiring bezlotoxumab in addition to oral fidaxomicin and intravenous metronidazole after failure of oral vancomycin and oral fidaxomicin. This case highlights the need to restructure the CD diagnostic algorithm to include earlier hypervirulent strain testing. Figure: Figure 1: Computed tomography of abdomen and pelvis demonstrating inflammatory changes of the sigmoid colon with peri-appendiceal fat stranding"

Endocrine Disorders • Hypotension • Infectious Disease • Metabolic Disorders

Treat the Patient, Not the Test: Endoscopically Diagnosed C. difficile Colitis With Repeatedly Negative Molecular Studies (ACG 2026) - "Case Description/ An 84-year-old woman with HTN, T2DM, GERD, CKD, severe aortic stenosis s/p TAVR, and complete heart block s/p pacemaker presented with 4 days of watery diarrhea ( >5/day) one day after completing 10 days of amoxicillin...Oral vancomycin 250 mg Q6H was added; piperacillin-tazobactam was stopped...Positive testing at recurrence retrospectively confirmed the index diagnosis, and extended-pulse fidaxomicin successfully treated recurrent disease...Figure: Figure 2. Continued colonoscopic findings extending through the mid-to-distal colon and rectum, showing universal pseudomembranous ulceration with serpentine plaques covering large mucosal areas (panels A-F)."

Clinical • Cardiovascular • Chronic Kidney Disease • Colorectal Cancer • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hypotension • Immunology • Infectious Disease • Type 2 Diabetes Mellitus

National Fidaxomicin Prescribing and Spending Trends for C. difficile Infection in Medicare Part D and Medicaid, 2019-2023 (ACG 2026) - "Fidaxomicin, a narrow-spectrum macrocyclic oral antibiotic, is guideline-preferred for CDI due to superior efficacy in reducing recurrence compared with vancomycin. Medicare Part D fidaxomicin spending rose from $44.5 million in 2019 to $127.2 million in 2023 (+186%). Claims increased from 11,904 to 28,662 (+141%) and beneficiaries from 9,154 to 21,562 (+136%). The sharpest increases occurred between 2020 and 2022."

Medicaid • Medicare • Reimbursement • US reimbursement • Infectious Disease

Hospitalization Burden by Age and Comorbidity in Adults With Recurrent Clostridioides difficile Infection: An Exploratory ECOSPOR III Analysis (ACG 2026) - " ECOSPOR III was a phase 3, randomized, double-blind trial of fecal microbiota spores, live-brpk vs placebo for prevention of rCDI. Adults with â¥3 CDI episodes in 12 months, toxin-positive CDI, and symptom resolution after 10â21 days of vancomycin or fidaxomicin were followed for 24 weeks... The ITT population included 182 patients (98.9% managed as outpatients); mean age was 65.6 years and mean age-adjusted CCI was 4.1â4.2 across treatment arms. Through week 24, 36 patients (19.8%) were admitted to the hospital for any reason, including 9 (4.9%) admitted for CDI recurrence. These patients accounted for 46 all-cause and 12 rCDI-related hospitalization events, with 3 patients each being hospitalized twice for CDI recurrence."

Clinical • Infectious Disease

Clostridioides difficile Infection as a Predictor of Chemotherapy-Related Adverse Outcomes in Colon Cancer (ACG 2026) - "Introduction: Chemotherapy-induced diarrhea affects 50-80% of colon cancer patients on fluorouracil/irinotecan regimens, causing dose reductions, treatment discontinuation, AKI, sepsis, and mortality...Cases had CDI (ICD-10 code: A04.7) within 90 days of the index date, confirmed by oral vancomycin or fidaxomicin prescription... After propensity score matching, 1,492 CDI and 1,492 non-CDI patients were included. Median age was 66 years (IQR 17); 47.3% were female. The CDI cohort had significantly higher rates of diarrhea at 14 days (HR 4.455; 95% CI, 2.996â6.625) and 30 days (HR 4.560; 95% CI, 3.383â6.146), chemotherapy-induced colitis (HR 3.702; 95% CI, 2.455â5.582), AKI within 30 days (HR 1.733; 95% CI, 1.405â2.137), sepsis within 30 days (HR 5.187; 95% CI, 2.951â9.117), neutropenia within 30 days (HR 2.178; 95% CI, 1.439â3.298), recurrent CDI days 30â180 (HR 37.181; 95% CI, 22.599â61.173), and emergency department visits within..."

Adverse events • Colon Cancer • Colorectal Cancer • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Bowel Disease • Mucositis • Neutropenia • Oncology • Septic Shock • Solid Tumor

Salmonella Terminal Ileitis With Endoscopic Inflammation Mimicking Crohn's Disease (ACG 2026) - "Concern for Crohnâs prompted initiation of a prednisone taper...Initially, he was given oral vancomycin, but when his symptoms persisted he was switched to fidaxomicin. He also received amoxicillin-clavulanate and azithromycin for an intercurrent respiratory infection...Terminal ileum inflammation in the presence of an enteric pathogen without histologic chronicity should caution premature IBD labeling and unnecessary acute and/or chronic immunosuppression exposure. Figure: Figure 1.: Terminal ileum mucosa revealing patchy erythema, edema, loss of normal villous architecture, and scattered shallow ulcerations extending from 15 cm proximal to the ileocecal valve (ICV)."

Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Respiratory Diseases • CRP

Emphysematous Gastritis With Portal Venous Gas Successfully Managed Nonoperatively (ACG 2026) - "One week prior, he was diagnosed with enteropathogenic E. coli and Clostridioides difficile infection without improvement despite oral vancomycin therapy...The patient improved with conservative medical management and was discharged on outpatient intravenous piperacillin-tazobactam and fidaxomicin therapy...Figure: E-G: Endoscopic view demonstrating diffuse inflammation of the gastric body, antrum, and pylorus. H: Endoscopic retroflexed view demonstrating diffuse inflammation of the cardia and fundus."

Cardiovascular • Diabetes • Dyslipidemia • Gastrointestinal Disorder • Hepatology • Hypertension • Infectious Disease • Inflammation • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Pulmonary Disease • Respiratory Diseases • Septic Shock • Type 2 Diabetes Mellitus

Fulminant Clostridioides difficile Infection Masquerading as Progression of Ischemic Colitis: A Diagnostic Pitfall (ACG 2026) - "She was treated with intravenous ertapenem with improvement...She was treated for fulminant CDI with oral vancomycin and intravenous metronidazole with symptom improvement, but due to persistent WBC >40 K/μL and repeat CT scan showing progressive pancolitis, she was transitioned to fidaxomicin (Figure 2B)...Figure: Figure 2. CT Abdomen/Pelvis showing A) worsening diffuse proctocolitis and B) progressive pancolitis."

Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Metabolic Disorders

Recurrent C. difficile Infection Is Characterized by Repeated Treatment Courses and Rising Costs Under Standard-of-Care Antibiotics (ACG 2026) - "Treatments included vancomycin, metronidazole, fidaxomicin, rifaximin, and/or bezlotoxumab; FDA-approved microbiome therapies were also captured. 11,256 patients with rCDI were identified; mean age was 66.6 (±17.0) years; 62% were aged â¥65 years with a mean Charlson Comorbidity Index of 2.95 (±2.65). In the 6 months before first observed recurrence, 53% had evidence of â¥2 prior treatment regimens, indicating a clinically complex population exposed to multiple successive CDI treatments. Of the 11,256 identified, 9,433 patients met the criteria for first observed line of therapy (LOT); 5,157 (55%) then received the next LOT."

Infectious Disease

A Gut-Restricted Antibiotic With a Systemic Surprise: Fidaxomicin-Induced Thrombocytopenia (ACG 2026) - "Case Description/ A 78-year-old man with end-stage renal disease on peritoneal dialysis, atrial fibrillation on apixaban, Parkinsonâs disease, and recent CDI was started on fidaxomicin for recurrent diarrhea...In individuals with end-stage renal disease or CDI-associated intestinal inflammation, increased intestinal permeability may lead to greater systemic drug exposure, a mechanism described with other minimally absorbed antimicrobials such as oral vancomycin...As fidaxomicin use increases, clinicians should be aware of this potential adverse effect, particularly in older adults with renal impairment or those receiving anticoagulation. Additional studies are needed to better define its incidence and underlying mechanism."

Atrial Fibrillation • Cardiovascular • CNS Disorders • Hematological Disorders • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Movement Disorders • Nephrology • Parkinson's Disease • Renal Disease • Septic Shock • Thrombocytopenia

Recurrent Clostridioides Difficile Infection Unmasking Elderly-Onset Crohn's Disease (ACG 2026) - "He completed a 10-day course of oral vancomycin followed by a 10-day course of fidaxomicin...A diagnosis of severe ileocolonic Crohn's disease was established, and intravenous methylprednisolone resulted in marked symptomatic improvement...(B) The terminal ileum is with erythema, friability, and shallow ulcerations. Large ulcers measuring 0.5-2 cm involve more than 75% of the mucosal surface of the (C) ascending colon, (D) descending colon, (E) sigmoid colon, and (F) rectum."

Clinical • Colorectal Cancer • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Geriatric Disorders • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Mucositis • Musculoskeletal Diseases • Orthopedics

Almost Colectomy: From Presumed C. difficile to Cisplatin-Induced Colitis (ACG 2026) - "He was treated empirically for presumed fulminant C. difficile colitis with broad-spectrum antibiotics, including vancomycin and fidaxomicin, and colectomy was considered due to lack of improvement. PCR positivity may be misleading, and lack of response to antibiotics should prompt consideration of alternative etiologies in such cases. Early endoscopic evaluation, carefully weighing the risk of adverse events against the need for definitive diagnosis, can guide therapy and potentially preserve the bowel in critically ill patients."

Acute Kidney Injury • Bladder Cancer • Diabetes • Dyslipidemia • Gastroenterology • Gastrointestinal Disorder • Genito-urinary Cancer • Hypertension • Hypotension • Immunology • Infectious Disease • Inflammatory Bowel Disease • Metabolic Disorders • Nephrology • Renal Disease • Solid Tumor • Type 2 Diabetes Mellitus

Fecal microbiota transplantation versus vancomycin or fidaxomicin in Clostridioides difficile infection first episode and first recurrence: a study protocol for a randomised, controlled, open-label, multicentre phase III clinical trial. (PubMed, BMJ Open) - P3 | "Results will be disseminated through peer-reviewed publications and conference presentations. NCT05266807."

Clinical protocol • Journal • P3 data • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Transplantation