Background: Current guidelines recommend the use of vancomycin for the initial treatment
of Clostridioides difficile Infection (CDI). Cadazolid, an experimental drug, has been utilized
and compared in several studies with varying results.
Methods: A systematic literature search was performed using electronic databases [Medline, Google
Scholar and Cochrane] for eligible studies. Randomized Controlled Trials (RCTs) comparing
cadazolid with vancomycin for CDI treatment were included. Demographic variables and outcomes
(CDI resolution, CDI recurrence, and adverse events) were collected. The primary outcome was
clinical cure rate defined as the resolution of CDI at the end of a 10-day course.
Results: Two studies with three RCTs met the inclusion criteria with a total of 1283 patients with
CDI who received either cadazolid 250 mg twice daily (624 patients) or vancomycin 125 mg four
times daily (659 patients). Clinical cure rate at the end of the treatment was not statistically significant
(pooled OR= 0.82; 95% CI = 0.61 to 1.11; p=0.20; I2= 0%). Sustained clinical response at
clinical follow-up was also not significantly different (pooled OR = 1.14; 95% CI = 0.91 to 1.43;
p=0.27; I2 = 0 %). Cadazolid had a lower recurrence rate than vancomycin (pooled OR = 0.71; 95%
CI = 0.52 to 0.98; p=0.04; I2 = 13 %).
Conclusion: Cadazolid is non-inferior to vancomycin and offers a promising alternative for the
treatment of CDI. More studies including RCTs and longitudinal studies with large and diverse
patient population are needed to further confirm this. Furthermore, cadazolid should also be compared
with fidaxomicin in a head-to-head trial to evaluate their efficacy for CDI.