P2436 - Comparative Efficacy of Antibiotic Treatments for Clostridioides difficile Infection: A Meta-Analysis of Randomized Controlled Trials

Sheenam Garg, MBBS¹, Arghadip Das, MBBS², Sai Nikhitha Malapati, MBBS³, Kushaghar Singla, MD⁴, Saif Syed, MD⁵, Aasim Akthar Ahmed, MD⁶, Priya Kumari Maheshwari, MD⁷, Mohammad Ali, MBBS⁸, Ibrahim Reyaz, MBBS⁹, Omer Farooq Mohammed, MBBS¹⁰, Binay Panjiyar, MD¹¹, Chanpreet Singh, MD¹²
1Punjab Institute of Medical Sciences, Centreville, VA; 2Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India; 3kamineni academy of medical sciences and research center, lb.nagar, hyderabad, india, Hyderabad, Telangana, India; 4University of Pennsylvania Health System, Claymont, DE; 5Indiana University Health, Indiana, IN; 6St. Francis Medical Center, Monroe, LA; 7University of Central Florida, HCA Healthcare GME, Pensacola, FL; 8Kakatiya Medical College, Hyderabad, Telangana, India; 9Nassau University Medical Center, East Meadow, NY; 10Osmania General Hospital and Medical College, Hyderabad, Telangana, India; 11NorthShore University Hospital, Manhasset, NY; 12South Texas Health System GME Consortium, McAllen, TX

Introduction: Clostridium difficile infection (CDI) remains a major contributor to hospital-acquired diarrhea, associated with significant morbidity, high recurrence rates, and substantial healthcare costs. Despite the availability of several antibiotic options, direct comparisons between these therapies are limited, and the best approach for reducing recurrence remains a topic of debate.

Methods: A meta-analysis was conducted, focusing on randomized controlled trials (RCTs) that evaluated different antibiotic treatments for CDI. Eligible studies, published between 2015 and 2025, were identified from six electronic databases and through screening 111 reference lists. Extracted data included clinical cure rates, sustained clinical response, and recurrence outcomes. Risk of bias was evaluated using RevMan version 5.4, which was also used to perform fixed-effects meta-analyses, calculating pooled odds ratios (ORs) with 95% confidence intervals (CIs).

Results:

The meta-analysis included four randomized controlled trials, encompassing a total of 1,368 patients. In terms of clinical cure, the results indicated no statistically significant difference between vancomycin and fidaxomicin or other emerging antibiotic agents, with an odds ratio (OR) of 1.03 (95% confidence interval [CI]: 0.78–1.35; I² = 76%). However, when evaluating recurrence rates, fidaxomicin and other novel therapies demonstrated a significantly greater reduction in recurrence compared to vancomycin, with an OR of 0.46 (95% CI: 0.33–0.64; I² = 44%).

Discussion: While clinical cure rates were comparable between fidaxomicin and vancomycin, fidaxomicin was more effective in preventing CDI recurrence, suggesting its potential benefit in high-risk patient populations. The EXTEND trial demonstrated that extended-pulsed fidaxomicin achieved higher rates of sustained clinical cure, especially among individuals infected with the PCR-ribotype 027 strain. Additionally, emerging treatments such as ridinilazole and LFF571 show potential as alternative options, pending further validation. These results highlight the critical role of antibiotic selection in improving outcomes for CDI.

Disclosures:
Sheenam Garg indicated no relevant financial relationships.
Arghadip Das indicated no relevant financial relationships.
Sai Nikhitha Malapati indicated no relevant financial relationships.
Kushaghar Singla indicated no relevant financial relationships.
Saif Syed indicated no relevant financial relationships.
Aasim Akthar Ahmed indicated no relevant financial relationships.
Priya Kumari Maheshwari indicated no relevant financial relationships.
Mohammad Ali indicated no relevant financial relationships.
Ibrahim Reyaz indicated no relevant financial relationships.
Omer Farooq Mohammed indicated no relevant financial relationships.
Binay Panjiyar indicated no relevant financial relationships.
Chanpreet Singh indicated no relevant financial relationships.

Sheenam Garg, MBBS¹, Arghadip Das, MBBS², Sai Nikhitha Malapati, MBBS³, Kushaghar Singla, MD⁴, Saif Syed, MD⁵, Aasim Akthar Ahmed, MD⁶, Priya Kumari Maheshwari, MD⁷, Mohammad Ali, MBBS⁸, Ibrahim Reyaz, MBBS⁹, Omer Farooq Mohammed, MBBS¹⁰, Binay Panjiyar, MD¹¹, Chanpreet Singh, MD¹². P2436 - Comparative Efficacy of Antibiotic Treatments for <i>Clostridioides difficile</i> Infection: A Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.