194 Cadazolid vs. Vancomycin for Treatment of Clostridioides difficile Infection: Systematic Review With Meta-Analysis

Abstract

INTRODUCTION: Current guidelines recommend the use of vancomycin for the initial treatment of Clostridioides difficile infection (CDI). Cadazolid, an experimental drug, has been utilized and compared in several studies with varying results. METHODS: A systematic literature search was performed using the following electronic databases [Medline, Google Scholar, and Cochrane] for eligible studies. Randomized controlled trials (RCTs) comparing cadazolid with vancomycin for CDI treatment were included. Demographic variables and outcomes (CDI resolution, CDI recurrence, adverse events) were collected. RESULTS: Two studies with three RCTs met the inclusion criteria with a total of 1283 patients with CDI who received either cadazolid 250 mg twice daily (624 patients) or vancomycin 125 mg four times daily (659 patients). Clinical cure rate at the end of treatment was not statistically significant (pooled odds ratio (OR) = 0.82; 95% confidence interval (CI) = 0.61 to 1.11; P = 0.20; I2 = 0%). Sustained clinical response at clinical follow-up was also not significantly different (pooled OR = 1.14; 95% CI = 0.91 to 1.43; P = 0.27; I2 = 0%). Cadazolid had a lower recurrence rate than vancomycin (pooled OR = 0.71; 95% CI = 0.52 to 0.98; P = 0.04; I2 = 13%). CONCLUSION: To our knowledge, this is the first systematic review and meta-analysis comparing the efficacy, recurrence rates, and safety profile of cadazolid and vancomycin, for the treatment of CDI. Our results indicate that cadazolid did not differ significantly from vancomycin in terms of achieving a higher clinical cure rate, sustained clinical response rate, or fewer adverse effects. However, cadazolid was associated with a lower rate of recurrences than vancomycin. Clostridioides difficile is a challenging pathogen to treat from a clinical perspective. In the last two decades, there has been a dramatic increase in both the incidence and severity of CDI. Hence, while cadazolid and vancomycin are generally safe and well tolerated, cadazolid had a lower CDI recurrence rate than vancomycin thus meriting its further evaluation.