fidaxomicin and Drug-Hypersensitivity

Systemic absorption of oral vancomycin for the treatment of Clostridium difficile is thought to be trivial in patients without risk factors for increased systemic absorption and is often overlooked in clinical practice. A 51-year-old male elicits a suspected immunoglobulin E-mediated hypersensitivity following administration of low-dose oral vancomycin for the treatment of severe C difficile. The patient had normal renal function and was administered low doses of the medication, however, had a medical history significant for diverticulitis. Applying the Naranjo adverse drug reaction probability scale, a score of 5 was obtained, indicating a probable association between the administration of oral vancomycin and the hypersensitivity reaction. This case demonstrates that hypersensitivity reactions following low-dose oral vancomycin administration in patients with severe C difficile are possible, despite having normal renal function. Other risk factors for systemic absorption of oral vancomycin need to be evaluated in the literature, including severity of disease and underlying gastrointestinal processes.

Topics: Administration, Oral; Aminoglycosides; Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Drug Hypersensitivity; Fidaxomicin; Humans; Kidney; Male; Middle Aged; Treatment Outcome; Vancomycin

We report hypersensitivity reactions associated with fidaxomicin, an antibacterial drug approved for the treatment of Clostridium difficile-associated diarrhea. These reactions are viewed as significant because of severity and unexpected because fidaxomicin is minimally absorbed. The fidaxomicin labeling was revised to include information about the possibility of hypersensitivity reactions.

Topics: Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Diarrhea; Drug Hypersensitivity; Female; Fidaxomicin; Humans; Male; Middle Aged