Summary

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• This summary is based on the review of eight systematic review(s)/meta-analysis(es). ^[1-8]
• Fidaxomicin and vancomycin demonstrate equivalent effectiveness as first-line treatments for mild to moderate clostridium difficile infection (CDI), with no significant difference in general efficacy.
• Fidaxomicin shows significantly lower recurrence rates than vancomycin at 40 days (relative risk (RR) = 0.52, 95% confidence interval (CI): 0.38-0.70, P < .01), 60 days (RR = 0.38, 95% CI: 0.21-0.69, P < .01), and 90 days (RR = 0.62, 95% CI: 0.50-0.77, P < .01). Cadazolid also reduces recurrence compared to vancomycin (pooled odds ratio (OR) = 0.71; 95% CI = 0.52 to 0.98; P = 0.04).
• Fidaxomicin improves 60-day all-cause mortality compared to vancomycin (RR = 0.57, 95% CI: 0.34-0.96, P = .03) and has superior sustained cure rates compared to vancomycin (OR: 1.61; 95% CrI: 1.27, 2.05) and metronidazole (OR: 2.39; 95% CrI: 1.65, 3.47).
• Fidaxomicin and vancomycin exhibited no significant differences in the incidence of clinical adverse reactions, all-cause mortality at 40 days, severe CDI, or recurrent CDI.
• Cadazolid showed a similar adverse event profile to vancomycin, with no significant differences in clinical cure rates or sustained clinical response.
• In severe CDI, vancomycin is more effective than fidaxomicin (RR = 0.94, 95% CI: 0.90-0.98, P < .01); for CDI in patients with inflammatory bowel disease (IBD), fidaxomicin or vancomycin is recommended for initial episodes, while fecal microbiota transplantation (FMT) is suggested for recurrent cases.