Transplants are typically reserved for those with recurrent CDI (although that is likely different in the US where I think you can pay for one privately). In Canada it is a covered procedure.
Not sure about Canada anymore, Queens was doing this in select cases when I was there, but FMT is also increasingly used for initial episode fulminant CDI in the US as well (varies by institution).
I was unlucky enough to get CDI in medical school when flagyl was first line and had to pay OOP for PO vanco, I assume that’s changed now.
What’s first line in Canada these days, is fidaxomycin covered?
Couldn’t tell you about inpatient hospital use. Outside of hospital, it’s covered by the public drug plan in Ontario if you’ve failed (or have allergies to) vancomycin treatment.
Metronidazole is still first line under that program for “mild” cases, otherwise it’s vanco. But nobody is really checking, so it comes down to how your doctor wants to document it.
Glad to hear approval for vanco is relaxed, this was 2015 when I think vanco first line was still new. I was also on the university drug plan which required documented treatment failure at that time.
I remember we used to give patients vanco IV bags to drink on discharge for outpatient therapy because the PO formulation was too expensive for some (iirc I paid $300 for a 10 day course).
