Vancomycin Is Out, Ridinilazole Is In? Comparing C Difficile Treatments

“Vancomycin” is undoubtedly the buzzword of this year’s IDWeek conference. The antibiotic is as powerful as it is controversial; it can wipe out good bacteria alongside the bad, allowing dangerous pathogens like Clostridioides difficile (C diff) to flourish unmitigated.

In an exclusive interview describing the research he shared at IDWeek 2022, Pablo C. Okhuysen, MD, FACP, FIDSA, referenced the “collateral side effects” of vancomycin. “Ridinilazole is an attractive agent,” he explains, “because in addition to being active against C difficile, it preserves the microbiome, and that prevents C difficile recurrences.”

Ridinilazole fell short of its superiority endpoint, but Okhuysen notes that the study patients who received ridinilazole were more likely to have a sustained clinical response. This means that they were less likely to experience C diff recurrences.

About 70% of the study cohort had not received antibiotics within 3 days of study enrollment, and among this subgroup, “The efficacy of ridinilazole in preventing recurrent C difficile infection was up to 63%,” said Okhuysen.

Importantly, the appeal of ridinilazole lies in its preservation of the microbiome. “We have to implement not only antimicrobial stewardship, but microbiome stewardship,” Okhuysen said.

Efficacy and Safety of Ridinilazole Compared with Vancomycin for the Treatment of Clostridioides difficile Infection,” at IDWeek 2022, held October 19-23, 2022, in Washington, D.C.