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Techniques in Coloproctology

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01.12.2024 | Original Article

Microbiome-preserving antibiotics for the treatment of Clostridioides difficile infection: a systematic review and meta-analysis

verfasst von: A. M. Kravets, R. Hanneke, R. L. Nelson

Erschienen in: Techniques in Coloproctology | Ausgabe 1/2024

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Abstract

Background

Newer antibiotics that specifically target Clostridioides difficile while preserving the host microbiome have emerged to treat C. difficile infection (CDI): cadazolid, fidaxomicin, ridinilazole, and surotomycin. The aim of the present study was to perform a systematic review and meta-analysis of efficacy for each antibiotic.

Methods

Only randomized clinical trials of patients being treated for Clostridioides disease infection were included. Studies were sought in MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization clinical trials register portal (up to December 9, 2022). Sustained clinical cure was the outcome of treatment comparison, defined as the resolution of diarrhea without recurrence. Vancomycin was the standard treatment comparator. Meta-analysis was performed for each antibiotic. The overall certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE)—classified as either high, moderate, low, or very low.

Results

Fourteen eligible studies were included in the meta-analysis with 4837 patients from 773 sites. Cadazolid did not increase sustained clinical cure relative to vancomycin (risk ratio (RR) 1.04, 95% confidence intervals (CI) 0.96–1.13; moderate-certainty evidence). Fidaxomicin demonstrated a significant increase (RR 1.14, 95% CI 1.07–1.21; low-certainty evidence). In one phase 2 study, ridinilazole demonstrated a significant increase in sustained clinical cure (RR 1.71, 95% CI 1.01–2.91; very low-quality evidence). Surotomycin did not show significant improvement (RR 1.05, 95% CI 0.96–1.14; moderate-certainty evidence).

Conclusions

Fidaxomicin (in seven studies) demonstrated significant improvement in achieving sustained clinical cure. A limitation of this study may that more studies are needed to compare fidaxomicin with other antibiotics.

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Titel: Microbiome-preserving antibiotics for the treatment of Clostridioides difficile infection: a systematic review and meta-analysis
verfasst von: A. M. Kravets
R. Hanneke
R. L. Nelson
Publikationsdatum: 01.12.2024
Verlag: Springer International Publishing
Erschienen in: Techniques in Coloproctology / Ausgabe 1/2024
Print ISSN: 1123-6337
Elektronische ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-023-02878-z

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Microbiome-preserving antibiotics for the treatment of Clostridioides difficile infection: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

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