Is Fidaxomicin Superior to Vancomycin for Patients Hospitalized With C difficile Infection?

Outcomes among patients hospitalized with Clostridioides difficile infection showed no preference for treatment with vancomycin compared with fidaxomicin.

Fidaxomicin is not associated with a shorter length of hospitalization or reduced admission rates among patients with Clostridioides difficile infection (CDI) compared with vancomycin, according to study results presented at IDWeek 2022, held from October 19 to 23, in Washington, DC.

Researchers evaluated updated clinical practice guidelines published in 2021 by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. These guidelines stipulated the preference for fidaxomicin over vancomycin for initial and recurrent CDI in hospitalized adults.

The researchers conducted a retrospective, multicenter, comparative evaluation of clinical outcomes in hospitalized patients with CDI who received either vancomycin, administered orally or rectally, or fidaxomicin between January 2017 and October 2021 to support or deny the recommended guidelines.

Among more than 45,000 patients included in the analysis, 76% received vancomycin, 6% received fidaxomicin, and 18% received neither antibiotic.

The researchers found that the length of hospitalization was decreased among patients who received vancomycin vs those who received fidaxomicin (median, 7 vs 9 days). Patients in the vancomycin group also demonstrated reduced readmission rates within 8 weeks following discharge compared with those in the fidaxomicin group (14.6% vs 18.5%, respectively; P <.0000005).

This study supports the continued use of oral/rectal vancomycin for CDI without preference for fidaxomicin.

Risk factors for CDI recurrence included age (≥65 years), immunocompromised status, and severe CDI diagnosis, defined as a leukocyte concentration above 15 cells/mm3 and a serum creatinine concentration above 1.5 mg/dL.

The researchers found that vancomycin reduced the risk for readmission among all patients who exhibited risk factors for CDI recurrence. Compared with fidaxomicin, receipt of vancomycin was associated with reduced readmission rates for those in both groups with more than 1 risk factor for CDI recurrence (13.4% vs 16.1%, respectively).

“This study supports the continued use of oral/rectal vancomycin for CDI without preference for fidaxomicin,” the researchers concluded.


Roemer K, Burgess H, Sands, KE, Hodgin R. Oral vancomycin versus fidaxomicin for Clostridiodes difficile: A comparative retrospective evaluation across a large, multi-center healthcare system. Presented at: IDWeek 2022; October 19-23; Washington, DC. Poster 397.