Hospital Insight Series

August 2009

Hospital Anti-Infectives Insight Series: Clostridium Difficile

Report Authors
Lisa Arias
John M. Lebbos, M.D.
Jacqueline Lyons, M.P.H.


Clostridium difficile infection (CDI) is a relatively common nosocomial infection and is often implicated in antibiotic-associated diarrhea. This infection has an important impact on the healthcare system due to increased morbidity, costly hospitalizations, troubling rates of severe disease and recurrent infections, and outbreaks caused by a new hypervirulent strain of C. difficile, BI/NAP1/027. With limited therapeutic options available and increasing reports of treatment failures, thought leaders and physicians surveyed highlight the necessity for new, more-effective CDI therapies that will not only treat the disease but will also prevent recurrences. In this report, we investigate current treatment practices and risk factors for CDI and analyze emerging therapies in the pipeline. In addition, we provide insight into the current and future challenges associated with treating CDI, which we gained from our survey of infectious disease specialists. Finally, we include a market forecast of CDI events based on epidemiological findings, survey data, and our understanding of the future market for CDI.

Questions Answered in This Report:

  *   Patient population: CDI affects a diverse population of patients, and infections range in severity. What comorbid conditions characterize the U.S. and European CDI patient populations? What are the top risk factors for CDI? What are the most challenging CDI patient populations to treat? What percentage of CDI patients require second- and later-line therapy? What percentage of CDI patients have recurrent infections?

  *   Prescribers: A variety of physicians treat CDI patients in the hospital, and specialties vary by country. Which specialties are responsible for treating CDI in the United States and Europe? For what percentage of CDI patients and antibiotic courses are different specialties responsible? Which specialties manage CDI patients after hospital discharge and CDI patients treated in the outpatient setting?

  *   Products and treatment patterns: Only oral vancomycin (ViroPharma’s Vancocin) and oral and intravenous metronidazole (Pfizer’s Flagyl, Sanofi Aventis’s Rodogyl, generics) are commonly used to treat CDI. However, different factors influence the use of each agent in CDI. How are specific antibiotics used in CDI? What percentage of antibiotics are prescribed for CDI by line of therapy? What are the most important attributes of oral metronidazole that drive a physician to use it for CDI? What are the most important attributes of oral vancomycin that drive a physician to use it for CDI? What percentage of CDI patients receive vancomycin and metronidazole for first-line, second-line, and recurrent therapy? Which antibiotics are most commonly associated with subsequent CDI?

  *   Forecast: Several novel therapies are in development for CDI. What are the most significant unmet needs in CDI? Which attributes should the ideal CDI agent possess? How will emerging therapies be used in the treatment of CDI? What are the current treatment patterns in CDI, and how will these patterns change in the next ten years? Against which products will new CDI agents primarily compete? What advantages do novel CDI therapies in the pipeline offer? What does the future market for CDI look like? What changes in CDI prescribing trends are foreseen by the infectious disease specialists we surveyed?


Using clinical audit data from the Arlington Medical Resources, Inc. (AMR), Hospital Antibiotic Market Guide (HAMG), proprietary epidemiology, and insight from surveys of more than 100 infectious disease specialists, we examine the use of antibiotics in CDI, including the following:

- Analysis of the use of current agents used to treat CDI by prescribing physician, line of therapy, and country (United States, France, Germany, Italy, Spain, and United Kingdom).

- Prescribing behavior for the top specialties that prescribe antibiotics for CDI in the United States and Europe.

- Patient comorbidities, hospitalization outcomes, settings in which treatment occurs, and average duration of inpatient therapy in the United States, France, Germany, Italy, Spain, and the United Kingdom.

We analyze the current marketplace and examine prescribing drivers of the infectious disease specialists surveyed, their reasons for prescribing key products, unmet needs, and their receptivity to emerging antibiotics that may be of potential use in CDI.

Fill out the form below to contact sales.

Search Reports

Decision Resources Group brands include: