Treatment Guideline

Standard Treatment

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2021 First Line Therapy – Fidaxomicin

• 2017 IDSA Guidelines
  • Oral vancomycin as 1^st line therapy
• 2021 IDSA Guidelines
  • Fidaxomicin 1^st → oral vancomycin an acceptable alternative
• Similar initial clinical response

• Proposed Benefits of Fidaxomicin:
  • Limited documented resistance
  • Used solely for CDI
  • Ease of dosing
  • Sustained response?

Conditional Recommendation

Moderate Certainty of Evidence

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Fidaxomicin in the Literature

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Literature Summary

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Hesitancy with Fidaxomicin?

• Cost and Resource Allocation
  • Fidaxomicin remains rough 4x more expensive than oral vancomycin
    • Oral vancomycin remains expensive
  • Lack of insurance or lack of insurance coverage
    • Unlikely to be able to afford fidaxomicin if no insurance
    • Many insurance companies still requiring prior authorization for fidaxomicin
• Limited number of cost-effectiveness studies – is the juice worth the squeeze?
• IDSA guidelines place high emphasis on potential clinical benefit

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Treatment Summary