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Finally, the cost of fidaxomicin is significantly higher than that of vancomycin. Given the limited data available, we urge caution in committing patients to a course of this drug before more definitive evidence of superiority in post-marketing clinical trials.

Previous CDI guidelines have not delineated when CDI patients should be evaluated for treatment failure once committed to a course of metronidazole for CDI or when a change from metronidazole to vancomycin or other agents is indicated. In the largest observational prospective study of metronidazole-treated CDI patients, 103 of 207 (50) had complete responses to 9 days of therapy. Of the remaining patients, 58 (28) had an initial response to metronidazole but developed recurrent CDI (RCDI) within 90 days.