Hi
Today we review a meta analysis evaluating the different treatment options available for Clostridium difficile infection (CDI). This meta analysis attempts to answer a few questions related to an emerging disease in the sub continent
Comparative efficacy of treatments for Clostridium difficile infection: a systematic review and network meta-analysis.
Beinortas et al 
Lancet Infect Dis 2018;18:  1035–44

This meta analysis could identify 24 comparative studies which evaluated two or more treatment options for CDI. A total of 5361 patients receiving 13 different treatment options were evaluated. The primary outcome measure was primary cure of diarrhea. Recurrence of infection was not an end point of interest for the meta analysis. Most of the studies included follow up of 28 days. Severity of the disease was not specified in 9 /24 studies. The most common therapy used was vancomycin followed by metronidazole and fidaxomicin. Most of the drugs were compared against Vancomycin. 17/24 studies included were industry sponsored. Teicoplanin and Fidaxomicin performed better than Vancomycin. Metronidazole performed inferiorly compared to most main line drugs. Tolevamer also did not perform well. Ridinilazole was significantly better than vancomycin in attaining a sustained symptomatic cure in patients with mild to moderate infections with C difficile and who were younger than 65 years. Teicoplanin, Ridinilazole and Fidaxomicin were the top three ranked drugs. However, the no of participants in the studies involving Teicoplanin were small and confidence intervals were wide. Ridinilazole appeared to be the best drug for prevention of recurrence in sub group analysis. The advantage of Teicoplanin seemed to decrease in the analysis when non blinded studies were excluded.
Therefore, fidaxomicin has the strongest evidence for being the most effective treatment
in providing a long-term cure against C difficile. Apart from affordability, there is little evidence to support use of metronidazole as a first-line treatment against infections with C difficile.
Early data for ridinilazole suggest that this treatment could potentially become a new, efficacious
treatment against infections with C difficile.

Drawbacks:
Majority of studies are industry sponsored
No stratification of severe infections

My view: Fidaxomicin seems to be the first choice. Teicoplanin can be used in mild to moderate cases. No overwhelming need to stick to Vancomycin. Metronidazole should be avoided.