2008
DOI: 10.1086/588293
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Comparison of Clinical and Microbiological Response to Treatment ofClostridium difficile–Associated Disease with Metronidazole and Vancomycin

Abstract: In an observational study with a limited number of subjects, a majority of patients with C. difficile-associated disease responded to therapy with metronidazole or vancomycin. Failure with metronidazole treatment may be attributable to a slower and less consistent microbiological response than that with oral vancomycin treatment.

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Cited by 149 publications
(96 citation statements)
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References 26 publications
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“…Accurate stratifi cation of patients based upon severity of disease using these criteria will ensure adequate and timely institution of appropriate therapy without over-treating too many patients. ( 50,51 ). In one, 150 patients were stratifi ed by an ad-hoc defi nition of CDI severity and then randomized to oral metronidazole or vancomycin ( 50 ).…”
Section: Management Of Mild Moderate and Severe CDImentioning
confidence: 99%
“…Accurate stratifi cation of patients based upon severity of disease using these criteria will ensure adequate and timely institution of appropriate therapy without over-treating too many patients. ( 50,51 ). In one, 150 patients were stratifi ed by an ad-hoc defi nition of CDI severity and then randomized to oral metronidazole or vancomycin ( 50 ).…”
Section: Management Of Mild Moderate and Severe CDImentioning
confidence: 99%
“…16,18 The relative risks of patient-related versus strainrelated factors for recurrence are unknown, as is the comparative efficacy of first-line agents in treating infections associated with the NAP1 strain of C. difficile. 21,22 The treatment of recurrent C. difficile infection is often based on empiric selection from relatively few options supported by limited clinical evidence. Accordingly, this paper reviews the recommendations of the Society for Hospital Epidemiology of America and the Infectious Diseases Society of America (SHEA-IDSA; guidelines published in May 2010) and the American College of Gastroenterology (ACOG; guidelines published in February 2013), as well as other references describing treatment strategies for first and second or later recurrence of C. difficile infection.…”
Section: R Ecurrentmentioning
confidence: 99%
“…25 However, more recent data, including results for patients with NAP1 infection, have indicated treatment failure rates up to 50% with metronidazole. 11,13,[21][22][23] In one prospective observational study of 52 patients with C. difficile infection, with 60% of cases associated with the NAP1 strain, those treated with vancomycin were more likely to have undetectable levels of C. difficile toxin (adjusted hazard ratio [HR] 3.99, 95% confidence interval [CI] 1.41-11.3; p = 0.09) and resolution of diarrhea (adjusted HR 4.17, 95% CI 1.53-11.4; p = 0.05) during the first 5 days of therapy than those who received metronidazole. 22 Furthermore, therapy was changed because of persistent symptoms in 29% (10/34) of patients treated with metronidazole but none of the 18 treated with vancomycin.…”
Section: Treatment Of First Recurrencementioning
confidence: 99%
“…[1][2][3][4][5]9,30 Some preliminary data and much theoretical speculation, however, have led to assertions that oral vancomycin may provide a small advantage in patients with more severe diseases and may be better at decreasing the rate of relapse. [30][31][32][33][34] One recent report suggests that treatment 'failure' with metronidazole may reflect a slower and more variable activity of metronidazole as compared with vancomycin. 33 Although the preferred use of these agents is currently debated, it is clear that metronidazole has more side effects than vancomycin, a drug that also has the advantage of being poorly absorbed and exhibiting near ideal pharmacologic characteristics for treating CDAD.…”
Section: Management Of Cdadmentioning
confidence: 99%
“…[30][31][32][33][34] One recent report suggests that treatment 'failure' with metronidazole may reflect a slower and more variable activity of metronidazole as compared with vancomycin. 33 Although the preferred use of these agents is currently debated, it is clear that metronidazole has more side effects than vancomycin, a drug that also has the advantage of being poorly absorbed and exhibiting near ideal pharmacologic characteristics for treating CDAD. 34 There are few, if any, studies to support combination therapy for CDAD, although it is generally recommended that the seriously ill CDAD patient be treated with a combination of oral vancomycin and i.v.…”
Section: Management Of Cdadmentioning
confidence: 99%