SUROTOMYCIN (A NOVEL ANTIBIOTIC) VS VANCOMYCIN FOR CLOSTRIDIUM DIFFICILE INFECTION: A SYSTEMATIC REVIEW AND META ANALYSIS

Background and Aim: Clostridium difficile infection (CDI), now recognized as leading cause of nosocomial diarrhea, poses a significant health burden. Current guidelines suggest the use of vancomycin for the initial treatment of moderate to severe CDI. Surotomycin, a new drug under investigation for the management of CDI, has been trialed for the management of CDI with variable results. Methods A systematic literature search was performed in electronic databases [Medline, Embase, Google Scholar and Cochrane] for eligible studies. Randomized controlled trials comparing Surotomycin with Vancomycin for the treatment of CDI were included. Case reports, case series, letter to editor, review articles and studies not evaluating resolution of CDI with treatment were excluded. Demographic variables and outcomes (CDI resolution, CDI recurrence, B1/NAP1/027-specific strain treatment, B1/NAP1/027-strain recurrence, death not related to treatment) were analyzed. The primary outcome was clinical cure rate defined as resolution of CDI at the end of treatment period which was 10 days for either drug. Pooled rates were reported using Odds ratio (OR) with 95% confidence interval (CI). Results Three RCTs met the inclusion criteria and were eligible for analysis with a total of 1356 patients with CDI who received either surotomycin (250mg twice daily; 644 patients; 51.4% females) or vancomycin (125 mg four times daily; control group; 642 patients; 54.2% females) Clinical cure rate after 10 days of receiving either surotomycin or vancomycin was not significantly different (pooled OR: 0.89, 95% CI 0.66-1.18, p=0.41). Sustained clinical response at > 40 days and the overall recurrence of CDI were also not significantly different between the 2 groups; pooled OR 1.15, (95% CI 0.89-1.49, p=0.29) and pooled OR 0.75 (95%CI 0.52-1.06, p=0.10) respectively. With regards to the B1/NAP1/027 strain, the clinical cure rate was not significantly different (pooled OR 0.64, 95%CI 0.27-1.53, p=0.31), however, patients in the surotomycin group had significantly lower rates of recurrence compared to vancomycin (pooled OR 0.36, 95% CI 0.19-0.66, p<0.01). Finally, mortality (not related to treatment) was not significantly different between the 2 groups (4.3% vs 3.4%). There was low heterogeneity in the inclusion studies. Conclusion The results for our systematic review and meta-analysis suggest that surotomycin was non-inferior to vancomycin in terms of clinical cure rates, sustained clinical response and in preventing recurrence of CDI. For management of CDI, surotomycin can be an alternative agent to vancomycin given its BID dosing schedule, different mode of action and prevention of recurrences for B1/NAP1/027 strain. [Figure Presented] [Figure Presented]