Clostridium difficile colitis that fails conventional metronidazole therapy: response to nitazoxanide

Musher, Daniel M.; Logan, Nancy; Mehendiratta, Vaibhav; Melgarejo, Nicolas; Garud, Sagar; Hamill, Richard J.

doi:10.1093/jac/dkl553

Cited by 113 publications

(61 citation statements)

References 34 publications

(37 reference statements)

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“…NTZ is not cross resistant with metronidazole, although their spectra against parasites and anaerobic bacteria are similar, and resistance to NTZ was not selected in H. pylori in vitro or in a clinical trial (251). Due to its anti-C. difficile activity and good safety and tolerability profile in humans, NTZ has been studied for the treatment of CDAD (266,267).…”

Section: Targeting Substrates and Cofactorsmentioning

confidence: 99%

Challenges of Antibacterial Discovery

Silver¹

2011

Clin Microbiol Rev

1,136

961

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SUMMARY The discovery of novel small-molecule antibacterial drugs has been stalled for many years. The purpose of this review is to underscore and illustrate those scientific problems unique to the discovery and optimization of novel antibacterial agents that have adversely affected the output of the effort. The major challenges fall into two areas: (i) proper target selection, particularly the necessity of pursuing molecular targets that are not prone to rapid resistance development, and (ii) improvement of chemical libraries to overcome limitations of diversity, especially that which is necessary to overcome barriers to bacterial entry and proclivity to be effluxed, especially in Gram-negative organisms. Failure to address these problems has led to a great deal of misdirected effort.

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Section: Targeting Substrates and Cofactorsmentioning

confidence: 99%

Challenges of Antibacterial Discovery

Silver¹

2011

Clin Microbiol Rev

1,136

961

View full text Add to dashboard Cite

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“…4,[35][36][37][38][39][40] Each of these drugs is approved in the United States for other types of gastrointestinal infections, and some clinicians have used either alone or in combination with metronidazole or vancomycin in patients with severe or recalcitrant CDAD. There are several small case reports addressing the potential efficacy of using adjuvant agents such as i.v.…”

Section: Management Of Cdadmentioning

confidence: 99%

“…Newer approaches include long, tapered or pulsed courses of vancomycin, as well as combination or sequential dosing with either rifaximin or nitazoxanide. [1][2][3][4][5]30,[35][36][37][38][39][40][41][42][43] An algorithm outlining our own approach is shown in Figure 2.…”

Section: Management Of Cdadmentioning

confidence: 99%

Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?

Bobak

Arfons

Creger

et al. 2008

Bone Marrow Transplant

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Clostridium difficile is the most common cause of nosocomial diarrhea in the United States and Europe, and is a cause of significant morbidity and mortality among hospitalized patients. A newly identified epidemic strain has been associated with many hospital outbreaks of C. difficile-associated disease (CDAD), raising the concern of an escalating burden of CDAD among at-risk patients. Hematopoietic SCT (HSCT) recipients are known to be at increased risk for a wide variety of infectious complications, including CDAD as a result of prolonged hospitalizations, exposure to broad-spectrum antibiotics, altered integrity of the intestinal mucosa and GVHD. The incidence of CDAD in the HSCT population has been reported as high as 20% in some large series. The frequency and seriousness of CDAD in this defined group as compared with the general hospital population, however, are not clearly delineated. We discuss the epidemiology and diagnosis of CDAD and review recent studies examining the risk factors and characteristics of CDAD in HSCT recipients. Finally, we provide a management algorithm for the diagnosis and treatment of CDAD at our institution.

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“…At 31 d after starting treatment, a sustained response was noted for 58% of patients treated with metronidazole vs 66% for the 7-d course of nitazoxanide and 74% for the 10-d course (P = 0.34). Musher et al [114] also reported the use of nitazoxanide in 35 patients that failed to respond to metronidazole after 14 d of therapy or who had prompt recurrence on at least two occasions after an initial response. They noted that 74% of patients responded, however, 7 of the 26 recurred, leaving an overall cure rate of 54%.…”

Section: Nitazoxanidementioning

confidence: 99%

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

Oldfield

Johnson

2014

WJGPT

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Clostridium difficile infection (CDI) presents a rapidly evolving challenge in the battle against hospitalacquired infections. Recent advances in CDI diagnosis and management include rapid changes in diagnostic approach with the introduction of newer tests, such as detection of glutamate dehydrogenase in stool and polymerase chain reaction to detect the gene for toxin production, which will soon revolutionize the diagnostic approach to CDI. New medications and multiple medical society guidelines have introduced changing concepts in the definitions of severity of CDI and the choice of therapeutic agents, while rapid expansion of data on the efficacy of fecal microbiota transplantation heralds a revolutionary change in the management of patients suffering multiple relapses of CDI. Through a comprehensive review of current medical literature, this article aims to offer an intensive review of the current state of CDI diagnosis, discuss the strengths and limitations of available laboratory tests, compare both current and future treatments options and offer recommendations for best practice strategies.

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Clostridium difficile colitis that fails conventional metronidazole therapy: response to nitazoxanide

Abstract: Nitazoxanide appears to provide effective therapy for patients with C. difficile colitis who fail treatment with metronidazole.

Cited by 113 publications

References 34 publications

Challenges of Antibacterial Discovery

Challenges of Antibacterial Discovery

Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

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