Chief residents of the NYU Langone Internal Medicine Residency give quick-and-easy, evidence-based answers to interesting questions posed by house staff, both in their clinics and on the wards.
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New guidelines released by the IDSA in June 2021 now state that for patients with an initial Clostridium Difficile Infection (CDI) episode, fidaxomicin is the preferred treatment, rather than a standard course of vancomycin, with moderate-certainty evidence. Furthermore, for patients with recurrent CDI, fidaxomicin is also preferred over vancomycin (low-certainty evidence). Fidaxomicin is preferred due to its minimal resistance pattern, minimal systemic absorption, and limited activity against other enteric bacteria. Studies also show a better sustained clinical response when compared to vancomycin (i.e. less subsequent recurrent symptoms).
References: IDSA and SHEA Guidelines for C. Diff
Until recently, liraglutide was the only approved GLP1-agonist approved for weight loss, based on supportive findings from the Evidence from the Satiety and Clinical Adiposity — Liraglutide Evidence in Nondiabetic and Diabetic Individuals Obesity and Prediabetes (SCALE) trial. More recently, a combination of diet and lifestyle, plus once-weekly semaglutide at a dose of 2.4 mg was studied in obese patients (BMI >30 or >27 if they had a comorbid condition) without diabetes. With follow-up to 68 weeks, patients had a mean change in body weight of -14.9% (compared to -2.4% with placebo). As of June of 2021, semaglutide (Wegovy) is now FDA-approved for weight loss in patients with a BMI >30 or >27 with a weight-related comorbid condition.
References: Weekly Semaglutide in Adults with Overweight or Obesity