Takeaway
- Follow-on rifaximin treatment showed a trend towards risk reduction for recurrence in patients after Clostridium difficile infection (CDI).
- Meta-analysis of the current and a previously published study suggests that rifaximin may be effective; however, larger confirmatory studies are needed.
Why this matters
- Rifaximin could be a useful additional therapeutic option to reduce recurrence, but larger studies would increase confidence in its use.
Study design
- Multisite, parallel group, randomised, placebo-controlled trial, RAPID, included patients aged ≥18 years immediately after resolution of CDI with metronidazole or vancomycin.
- 130 participants were randomly assigned to receive either rifaximin or placebo.
- The primary outcome was CDI recurrence within 12 weeks of randomisation.
- Secondary outcomes were: recurrence of CDI within 6 months; rehospitalisation for CDI within 6 months; length of in-hospital stay following start of trial medication.
- Funding: National Institute for Health Research.
Key results
- Mean age was 71.9 years.
- No statistical difference was observed in the risk for CDI recurrence within 12 weeks between rifaximin and placebo (29.5% vs 15.9%; risk ratio [RR], 0.54; P=.06).
- Within 6 months, no statistical difference was observed in:
- Recurrence (RR, 0.65; 95% CI, 0.36-1.16).
- Hospitalisation for recurrence (RR, 1.04; 95% CI, 0.43-2.52).
- Length of hospital stay following the start of treatment (HR, 0.94; 95% CI, 0.52-1.71).
- Adverse event rates were similar between groups.
- Meta-analysis of the current and previously published study suggests that follow-on rifaximin showed an overall absolute reduction in risk for recurrence of 14% (P=.01).
Limitations
- Planned sample size was not achieved.
References
References
