S413 Comparative Efficacy of Antibiotic Treatments for Clostridioides difficile Infection: A Meta-Analysis of Randomized Controlled Trials

Introduction: Clostridioidesdifficile 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 6 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 4 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 OR of 1.03 (95% 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%). Conclusion: 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.