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Recurrence of Clostridium difficile infection (CDI) is common, whether metronidazole or vancomycin is used as initial therapy. Fidaxomicin, a new macrocyclic antibiotic that has no cross-resistance with other antibiotics, is more active in vitro than vancomycin against clinical C. difficile isolates; in a phase II trial, it was associated with good clinical response and a low CDI recurrence rate. Now, in a manufacturer-sponsored, multicenter, double-blind, phase III trial, researchers have compared this agent with oral vancomycin in 629 adults with CDI.
Participants were randomized to receive fidaxomicin (200 mg twice daily) or vancomycin (125 mg 4 times daily) orally for 10 days. The primary endpoint was clinical cure (resolution of diarrhe…