Antibiotic treatment for Clostridium difficile-associated diarrhea in adults

Abstract

Current evidence leads to uncertainty whether mild CDAD needs to be treated. Patients with mild CDAD may resolve their symptoms as quickly without treatment. The only placebo-controlled study shows vancomycin's superior efficacy. However, this result should be treated with caution due to the small number of patients enrolled and the poor methodological quality of the trial. The Johnson study of asymptomatic carriers also shows that placebo is better than vancomycin or metronidazole for eliminating C. difficile in stool during follow-up. If one does decide to treat, then two goals of therapy need to be kept in mind: improvement of the patient's clinical condition and prevention of spread of C. difficile infection to other patients. Given these two considerations, one should choose the antibiotic that brings both symptomatic cure and bacteriologic cure. In this regard, teicoplanin appears to be the best choice because the available evidence suggests that it is better than vancomycin for bacteriologic cure and has borderline superior effectiveness in terms of symptomatic cure. Teicoplanin is not readily available in the United States, which must be taken into account when making treatment decisions in that country.

The effects of statins on the clinical outcomes ofClostridium difficileinfection in hospitalised patients

“…Thus, the values included in the score were obtained as close as possible to the date of diagnosis of CDI. Peak serum creatinine and WBC counts (defined as the highest value within 7 days of CDI diagnosis) have been correlated with increased complications and mortality in CDI by other investigators . In our study, low serum albumin and high serum creatinine, but not CRP, were associated with treatment failure when measured within 3 days of the CDI diagnosis.…”

“…Peak serum creatinine and WBC counts (defined as the highest value within 7 days of CDI diagnosis) have been correlated with increased complications and mortality in CDI by other investigators. 41 In our study, low serum albumin and high serum creatinine, but not CRP, were associated with treatment failure when measured within 3 days of the CDI diagnosis. We postulated that a greater disease severity is associated with a decreased response to metronidazole.…”

The effects of statins on the clinical outcomes ofClostridium difficileinfection in hospitalised patients

“…Thus, the values included in the score were obtained as close as possible to the date of diagnosis of CDI. Peak serum creatinine and WBC counts (defined as the highest value within 7 days of CDI diagnosis) have been correlated with increased complications and mortality in CDI by other investigators . In our study, low serum albumin and high serum creatinine, but not CRP, were associated with treatment failure when measured within 3 days of the CDI diagnosis.…”

“…Peak serum creatinine and WBC counts (defined as the highest value within 7 days of CDI diagnosis) have been correlated with increased complications and mortality in CDI by other investigators. 41 In our study, low serum albumin and high serum creatinine, but not CRP, were associated with treatment failure when measured within 3 days of the CDI diagnosis. We postulated that a greater disease severity is associated with a decreased response to metronidazole.…”

Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system

“…Peak serum creatinine and peak leukocytosis (defined as the highest value within 1 week of CDD diagnosis) have been correlated with increased complications and mortality in CDD by other investigators. 5 In our study, leukocytosis, but not creatinine, was associated with metronidazole failure when measured within 3 days of the time of CDD diagnosis.…”

Antimicrobial activity of lacticin 3147 against clinical Clostridium difficile strains

“…Antibiotic treatment has been shown to be a predisposing factor in the acquisition of CDAD; patients suffering from CDAD are mainly treated with oral vancomycin or metronidazole (Bricker et al, 2005;Ohl et al, 2005). However, recurrent diarrhoea has been shown in 5-20 % of patients receiving antibiotic treatment for CDAD (McFarland, 2005;Poutanen & Simor, 2004).…”

The effects of statins on the clinical outcomes ofClostridium difficileinfection in hospitalised patients

“…Thus, the values included in the score were obtained as close as possible to the date of diagnosis of CDI. Peak serum creatinine and WBC counts (defined as the highest value within 7 days of CDI diagnosis) have been correlated with increased complications and mortality in CDI by other investigators . In our study, low serum albumin and high serum creatinine, but not CRP, were associated with treatment failure when measured within 3 days of the CDI diagnosis.…”

“…Peak serum creatinine and WBC counts (defined as the highest value within 7 days of CDI diagnosis) have been correlated with increased complications and mortality in CDI by other investigators. 41 In our study, low serum albumin and high serum creatinine, but not CRP, were associated with treatment failure when measured within 3 days of the CDI diagnosis. We postulated that a greater disease severity is associated with a decreased response to metronidazole.…”

Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system

“…Peak serum creatinine and peak leukocytosis (defined as the highest value within 1 week of CDD diagnosis) have been correlated with increased complications and mortality in CDD by other investigators. 5 In our study, leukocytosis, but not creatinine, was associated with metronidazole failure when measured within 3 days of the time of CDD diagnosis.…”

Antimicrobial activity of lacticin 3147 against clinical Clostridium difficile strains

“…Antibiotic treatment has been shown to be a predisposing factor in the acquisition of CDAD; patients suffering from CDAD are mainly treated with oral vancomycin or metronidazole (Bricker et al, 2005;Ohl et al, 2005). However, recurrent diarrhoea has been shown in 5-20 % of patients receiving antibiotic treatment for CDAD (McFarland, 2005;Poutanen & Simor, 2004).…”

The effects of statins on the clinical outcomes ofClostridium difficileinfection in hospitalised patients

“…Thus, the values included in the score were obtained as close as possible to the date of diagnosis of CDI. Peak serum creatinine and WBC counts (defined as the highest value within 7 days of CDI diagnosis) have been correlated with increased complications and mortality in CDI by other investigators . In our study, low serum albumin and high serum creatinine, but not CRP, were associated with treatment failure when measured within 3 days of the CDI diagnosis.…”

“…Peak serum creatinine and WBC counts (defined as the highest value within 7 days of CDI diagnosis) have been correlated with increased complications and mortality in CDI by other investigators. 41 In our study, low serum albumin and high serum creatinine, but not CRP, were associated with treatment failure when measured within 3 days of the CDI diagnosis. We postulated that a greater disease severity is associated with a decreased response to metronidazole.…”

Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system

“…Peak serum creatinine and peak leukocytosis (defined as the highest value within 1 week of CDD diagnosis) have been correlated with increased complications and mortality in CDD by other investigators. 5 In our study, leukocytosis, but not creatinine, was associated with metronidazole failure when measured within 3 days of the time of CDD diagnosis.…”

Antimicrobial activity of lacticin 3147 against clinical Clostridium difficile strains

“…Antibiotic treatment has been shown to be a predisposing factor in the acquisition of CDAD; patients suffering from CDAD are mainly treated with oral vancomycin or metronidazole (Bricker et al, 2005;Ohl et al, 2005). However, recurrent diarrhoea has been shown in 5-20 % of patients receiving antibiotic treatment for CDAD (McFarland, 2005;Poutanen & Simor, 2004).…”