fidaxomicin and Bacterial-Infections

Diarrhoea is one of the most commonly occurring diseases. This article presents a review of the current state of the treatment of acute infectious diarrhoea, as well as of the most important pathogens. The general principles of the therapy of diarrhoea are exemplified, followed by a description of the targeted antimicrobial therapy of the most important bacterial gastrointestinal infections, including salmonellosis, shigellosis and Campylobacter infections, as well as infections with pathogenic Escherichia coli strains, yersiniosis and cholera. Diarrhoea caused by toxigenic Clostridium difficile strains has increased in incidence and in severity. These infections will therefore be described in detail, including important new aspects of treatment. Symptomatic therapy is still the most important component of the treatment of infectious diarrhoea. However, empirical antibiotic therapy should be considered for severely ill patients with a high frequency of stools, fever, bloody diarrhoea, underlying immune deficiency, advanced age or significant comorbidities. Increasing resistance, in particular against fluoroquinolones, must be taken into consideration. Therapy with motility inhibitors is not recommended for Shiga toxin-producing Escherichia coli (STEC) infections, Clostridium difficile infections (CDI), and severe colitis. The macrocyclic antibiotic fidaxomicin can reduce the rate of recurrent disease in CDI. Furthermore, evidence for the benefits of faecal microbiota transplantation as a treatment option for multiple recurrences of CDI is increasing. In conclusion, the treatment of acute diarrhoea is still primarily supportive. General empirical antibiotic therapy for acute diarrhoea is not evidence-based.

Topics: Acute Disease; Aminoglycosides; Anti-Bacterial Agents; Azithromycin; Bacterial Infections; Campylobacter Infections; Cholera; Ciprofloxacin; Diarrhea; Dysbiosis; Dysentery, Bacillary; Enterocolitis, Pseudomembranous; Escherichia coli Infections; Fidaxomicin; Gastroenteritis; Humans; Rifamycins; Rifaximin; Salmonella Infections; Shiga-Toxigenic Escherichia coli; Yersinia Infections

All courses of fidaxomicin use in the study hospital were reviewed. It was used for first recurrence (six times), second recurrence (eight times) and one case of third recurrence. One patients received fidaxomicin as first-line treatment. Eight patients initially responded to therapy; of these, three patients were asymptomatic at 90 days, three patients remained asymptomatic at 30 days, and two patients had recurrences five and nine days after stopping therapy. Four patients failed to respond; of these, two patients required faecal transplantation and one patient required a colectomy. Two patients deteriorated and two patients died. Fidaxomicin was well tolerated. These findings suggest that the utility of fidaxomicin at this stage of infection is unclear.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Female; Fidaxomicin; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Tertiary Care Centers; Treatment Outcome; United Kingdom

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Ceftaroline; Cephalosporins; Clostridioides difficile; Drug Resistance, Multiple, Bacterial; Enterocolitis, Pseudomembranous; Fidaxomicin; Humans; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Clostridioides difficile; Enterocolitis, Pseudomembranous; Fidaxomicin; Humans; Metronidazole; Secondary Prevention; Streptococcal Infections; United States; United States Food and Drug Administration; Vancomycin