Breakpoints

#34 – The New Scoop on Poop: Updates in the Management of C. difficile infections

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Dr. Kevin Garey (@GareyKgarey), Dr. Kelly Reveles (@KellyReveles), Dr. Mandelin Cooper, and host Dr. Rachel Britt (@RachelBPharmD) discuss proposed updates of the IDSA-SHEA C. difficile guidelines, including: fidaxomicin over oral vancomycin as first-line therapy, the roles and logistical hurdles of fecal microbiota transplant, bezlotoxumab, and the pros and cons of prophylaxis.

Timestamps

1:16 - Panel introductions

3:19 - Fidaxomicin vs PO vancomycin for first occurrence
7:21 - Fidaxomicin cost effectiveness
11:26 - Factors to consider for health systems when considering switch to fidaxomicin
14:23 - Fidaxomicin vs PO vancomycin for recurrences
17:52 - Role of pulsed and tapered PO vancomycin
19:57 - Role of fecal microbiota transplant (FMT)
22:24 - Challenges of FMT and where pharmacy fits in
27:27 - Bezlotoxumab
31:54 - Feasibility issues with bezlotoxumab and strategies to address them
35:25 - CDI prophylaxis
40:28 - Stewardship's role in reducing C. difficile infections

References

Fidaxomicin Cost-effectiveness

  • Reveles KR, et al. Pharmacotherapy. 2017;37(12):1489-97.
  • Watt M, et al. Infection. 2016;44(5):599-606.
  • Cornely OA, et al. J Antimicrob Chemother. 2018;73(9):2529-39.
  • Rubio-Terres C, et al. Eur J Clin Microbiol Infect Dis. 2019;38(6):1105-11.

    • Bezlotoxumab

    • Wilcox MH, et al. N Engl J Med. 2017;376:305-17.
    • Oksi J, et al. Eur J Clin Microbiol Infect Dis. 2019;38(10):1947-52.
    • Hengel RL, et al. Open Forum Infect Dis. 2020;7(4):ofaa097.

      • Bezlotoxumab Cost-effectiveness

      • Salavert M, et al. Adv Ther. 2018;35(11):1920-34.
      • Prabhu VS, et al. Clin Infect Dis. 2018;66(3):355-62.

        • Primary prophylaxis 

        • Pereiras MA, et al. Biol Blood Marrow Transplant. 2017; 23:S395. 
        • Ganetsky A, et al. Clin Infect Dis. 2019;68(12):2003-2009.
        • Mullane KM, et al. Clin Infect Dis. 2019; 68(2):196–203.

          • Secondary prophylaxis  

          • Carignan A, et al. Am J Gastroenterol. 2016;111:1834-1840.
          • Van Hise NW, et al. Clin Infect Dis. 2016;63:651-653.
          • Splinter et al. Ann Pharmacother. 2018;52:113-119.
          • Knight EM, et al. J Pharm Pract. 2019;:897190019825994.
          • Morrisette T, et al. Biol Blood Marrow Transplant. 2019;25(10):2091-2097.
            • ...more
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