Fidaxomicin or Vancomycin for a First Episode of C. diff in Immunocompromised Patients?

Fidaxomicin is associated with lower recurrence rates than vancomycin when used to treat an initial episode of Clostridioides difficile infection (CDI), but its high cost drives the need for careful patient selection. Now, researchers have compared the two drugs in a particularly vulnerable population — those with immune compromise.

This retrospective study included approximately 2400 immunocompromised patients who were treated for a first episode of CDI between 2013 and 2024. About 40% received vancomycin, 30% metronidazole (no longer recommended as a first-line agent), and 5% fidaxomicin; treatment was not specified for the remainder.