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Fidaxomicin: A New Addition to the Clostridium difficile Armamentarium

P Brandon Bookstaver, PharmD, BCPS (AQ-ID), AAHIVE1, Teldrin D James, PharmD Candidate1, Wajid Siddiqui, MD2, Christopher M Bland, PharmD, BCPS3, Yasir Ahmed, MD4, Marla D Koch, PharmD Candidate1, April Miller Quidley, PharmD, BCPS5

The incidence of Clostridium difficile infection (CDI) has increased throughout Canada, Europe, and the US in the last decade, including more cases in young, healthy persons and postpartum women [1–4]. It remains a clinically important nosocomial pathogen, with an increasing incidence of community-acquired disease. Estimates indicate an overall disease incidence of 20–30 cases per 100000 persons with approximately 20–25% of cases occurring in the community [2,3]. The most common and important risk factor is the use of broad-spectrum antibiotics or concomitant use of multiple antimicrobials for protracted courses [5–7]. Other recognized risk factors for C difficile-associated diarrhea (CDAD) include advanced age (≥65 years), female sex, recent solid organ transplantation or gastrointestinal (GI) surgery, use of immunosuppressive drugs or acid suppressive medications, prolonged hospitalization, malnutrition, nasogastric tube feeding, and the presence of multiple comorbidities [8–12]. With increasing incidence, much attention has focused on optimizing the treatment of CDI, specifically reducing recurrence. Disease recurrence, or a return of symptoms after initial treatment, may be caused by relapse of initial infection or reinfection and occurs in approximately 20–25% of patients [13].

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