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

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.