Which medications are most effective in treating Clostridium difficile (C diff) colitis in patients with cancer?

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
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Answer

In a multicenter study including 1105 subjects with C difficile–associated diarrhea, 183 of whom had solid tumors or hematologic malignancies, fidaxomicin treatment was superior to vancomycin treatment in cancer patients, resulting in higher cure and sustained response rates for diarrhea, shorter time to resolution of diarrhea (TTROD), and fewer recurrences. [73, 74]

Cure rates for diarrhea in the study were lower overall in cancer patients (79.2%) than in others (88.6%). [74] Cure rates for noncancer patients were approximately the same with fidaxomicin (88.5%) as with vancomycin (88.7%); however, those for cancer patients were higher with fidaxomicin than with vancomycin (85.1% vs 74.0%), although the difference was not statistically significant. Median TTRODs in noncancer patients were 54 hours with fidaxomicin and 58 hours with vancomycin; those in cancer patients were 74 and 123 hours, respectively.

In the same study, the risk of recurrence was approximately twice as high with vancomycin as with fidaxomicin, regardless of whether the patients had cancer or not, but because cure and recurrence outcomes were better with fidaxomicin than with vancomycin in cancer patients, the relative odds of sustained response at 28 days in these patients were more than 2.5-fold higher for fidaxomicin than for vancomycin. [74]


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