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Physician's
First Watch for February 3, 2011
David G. Fairchild, MD, MPH, Editor-in-Chief
 Fidaxomicin
Lowers C. difficile Recurrence, Compared with Vancomycin
HPV
Vaccine Seems Effective in Young Men
Featured
in Journal Watch: Traffic-Related Air Pollutants and Autism
Fidaxomicin Lowers C. difficile Recurrence, Compared
with Vancomycin
In comparison with vancomycin, the
macrocyclic antibiotic fidaxomicin lowered recurrence rates of Clostridium
difficile infection, according to a New England Journal of Medicine
study.
In a phase III noninferiority trial
sponsored and conducted by the manufacturer, researchers randomized some
600 patients to 10 days of either fidaxomicin or vancomycin. The rate of
clinical cure in those receiving at least one dose of the medication was about
85% in both groups. Recurrence rates among those with the most virulent C.
difficile strains were similar for both regimens (about 25%), but for
other strains, fidaxomicin conferred a much lower recurrence rate (8%) than
vancomycin (26%).
Laboratory abnormalities — specifically,
hyperuricemia and elevated transaminases — were significantly more common
with fidaxomicin.
An editorialist says that fidaxomicin,
while needing additional study, seems an "important advance." In Journal
Watch Infectious Diseases, Dr. Larry Baddour writes, "I hope that
this is the case — new, more-effective treatments [for C. difficile
infection] are badly needed."
NEJM article
(Free abstract)
NEJM editorial
(Subscription required)
Journal Watch Infectious Diseases summary (Free)
HPV Vaccine Seems Effective in Young Men
Vaccinating young men against human
papillomavirus appears to be effective in preventing external genital
lesions, according to an international trial supported and conducted by the
manufacturer and published in the New England Journal of Medicine.
Roughly 4000 males aged 16 to 26 years
who had five or fewer lifetime sexual partners were randomized to receive
either three doses of quadrivalent HPV vaccine or placebo. After a median
follow-up of 2.9 years, the vaccine had an efficacy of 60% in preventing external
genital lesions. The efficacy was 66% when considering only lesions related
to HPV-6, 11, 16, or 18. The vaccine also reduced the incidence of
persistent infection with these four HPV types and the DNA detection of
related HPV types.
The authors conclude: "Although the
point efficacy estimates for the boys and men in this study are numerically
lower than those for girls and women in previous studies, the confidence
intervals overlap, suggesting that vaccine efficacy may be similar for the
two sexes."
NEJM article
(Free abstract)
NEJM perspective
(Subscription required)
Featured in Journal Watch: Traffic-Related Air Pollutants and
Autism
A mother's residing close to a freeway at
the time of delivery was linked to a greater risk for autism.
Journal Watch Pediatrics and Adolescent Medicine summary (Your Journal Watch subscription required)
Physician-Editors contributing to this issue were: Susan Sadoughi, MD, and Danielle Bowen Scheurer, MD, MSc.
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