Got this incorrect on an amboss question which stated fidaxomicin over vancomycin. UpToDate confirms (Clostridioides difficile infection in adults: Treatment and prevention -> Management -> Nonfulminant Disease)
Unsure about the extra with poor oral bioavailability if that's the same for fidaxomicin, couldn't exactly tell
"Initial episode – For patients with an initial CDI episode of CDI (regardless of severity), we suggest fidaxomicin over vancomycin (table 2) (Grade 2C), given a small benefit with respect to recurrence rates. Patients with severe CDI also warrant assessment for surgical indications (table 3). (See 'Initial episode' above.)
•Recurrent episodes – Recurrent CDI is defined by resolution of CDI symptoms while on appropriate therapy, followed by reappearance of symptoms within two months of discontinuing treatment. The management approach varies depending on the number of recurrences (see 'Recurrent episode' above):
-For patients with a first or second CDI recurrence, we suggest a fidaxomicin-based regimen over a vancomycin-based regimen (Grade 2C). These agents may be administered with standard dosing or in an extended-pulsed regimen (table 2). In addition, for patients with prior CDI within the last six months, we suggest adjunctive use of bezlotoxumab (Grade 2C). (See 'First recurrence' above and 'Second or subsequent recurrence' above.)"
see shmuelsash suggestion, will probably go with that, need to defer to uworld questions regarding this not amboss questions for now
Watch Macrolides
Watch Clostridioides difficile
.jpg)
Watch associated Bootcamp video - Antibiotics: Aminopenicillins
Watch associated Bootcamp video - Antibiotics: Empiric Antibiotics in GI, Skin, Bone, and Hematogenous Infections