Nitazoxanide versus Vancomycin in<i>Clostridium difficile</i>Infection: A Randomized, Double‐Blind Study

Musher, Daniel M.; Logan, Nancy; Bressler, Adam; Johnson, David; Rossignol, Jean‐François

doi:10.1086/596552

Cited by 170 publications

(98 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mean age for our C. difficile population is representative of the standard age for trauma patients, but is significantly younger than that commonly accepted for CDI patients [5,12,16,17]. We found the prevalence of C. difficile infection in our patients to be lower than the 3% reported in the general hospital population [18], as well as that reported previously in the trauma population by Lumpkin et al [12].…”

Section: Discussionsupporting

confidence: 62%

“…Background for this includes studies on posttransplant patients with active immunosuppression as well as patients undergoing oncologic therapy who are at increased risk for CDI despite the lack of exposure to antimicrobial [6]. Co-morbidities known to affect the immune response have also been shown to be associated with C. difficile [17,19], which may explain the increased risk in the aging population, which is known to undergo immunosenescence [16,20]. In addition, specific genetic polymorphisms have been shown to be associated with increased risk for development of primary infection with C. difficile, as well as recurrences [12,14,[21][22][23].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

Vanzant

Ozrazgat‐Baslanti

Liu

et al. 2015

Surgical Infections

View full text Add to dashboard Cite

Background: The epidemiology of Clostridium difficile-associated infection (CDI) has changed, and it is evident that susceptibility is related not only to exposures and bacterial potency, but host factors as well. Several small studies have suggested that CDI after trauma is associated with a different patient phenotype. The purpose of this study was to examine and describe the epidemiologic factors associated with C. difficile in blunt trauma patients without traumatic brain injury using the Trauma-Related Database as a part of the ''Inflammation and Host Response to Injury'' (Glue Grant) and the University of Florida Integrated Data Repository. Methods: Previously recorded baseline characteristics, clinical data, and outcomes were compared between groups (67 C. difficile and 384 uncomplicated, 813 intermediate, and 761 complicated non-C. difficile patients) as defined by the Glue Grant on admission and at days seven and 14. Results: The majority of CDI patients experienced complicated or intermediate clinical courses. The mean ages of all cohorts were less than 65 y and CDI patients were significantly older than uncomplicated patients without CDI. The CDI patients had increased days in the hospital and on the ventilator, as well as significantly higher new injury severity scores (NISS), and a greater percentage of patients with NISS > 34 points compared with non-CDI patients. They also had greater Marshall and Denver multiple organ dysfunction scores than non-CDI uncomplicated patients, and greater creatinine, alkaline phosphatase, neutrophil count, lactic acid, and P i O 2 : F i O 2 compared with all non-CDI cohorts on admission. In addition, the CDI patients had higher glucose concentrations and base deficit from uncomplicated patients and greater leukocytosis than complicated patients on admission. Several of these changes persisted to days seven and 14. Conclusion: Analysis of severe blunt trauma patients with C. difficile, as compared with non-CDI patients, reveals evidence of increased inflammation, immunosuppression, worse acute kidney injury, higher NISS, greater days in the hospital and on the ventilator, higher organ injury scores, and prolonged clinical courses. This supports reports of an increased prevalence of CDI in a younger population not believed previously to be at risk. This unique population may have specific genomic or inflammation-related risk factors that may play more important roles in disease susceptibility. Prospective analysis may allow early identification of at-risk patients, creation of novel therapeutics, and improved understanding of how and why C. difficile colonization transforms into infection after severe blunt trauma.

show abstract

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

Vanzant

Ozrazgat‐Baslanti

Liu

et al. 2015

Surgical Infections

View full text Add to dashboard Cite

show abstract

“…Patients included in the study were those who had confirmed positive tests for C. difficile toxins, had more than 3 unformed stools within a 24 hour period and presented with at least one of the following: abdominal pain, fever or leukocytosis. 68 Response rates of 77% for nitazoxanide and 74% for vancomycin were noted initially. Initial response rates in the study were defined as the absence of any CDI symptoms between days 11-13.…”

Section: Nitazoxanidementioning

confidence: 98%

The potential for emerging therapeutic options forClostridium difficileinfection

et al. 2014

View full text Add to dashboard Cite

“…Most recently, Musher et al [115] completed a randomized, double-blind study of nitazoxanide vs vancomycin. After 10 d of treatment, resolution of CDI occurred in 20 of 27 vancomycin patients (74%) and 17 of 22 nitazoxanide patients (77%)…”

Section: Nitazoxanidementioning

confidence: 99%

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

Oldfield

Johnson

2014

WJGPT

View full text Add to dashboard Cite

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.

show abstract

Nitazoxanide versus Vancomycin inClostridium difficileInfection: A Randomized, Double‐Blind Study

Abstract: ClinicalTrials.gov identifier: NCT00384527.

Cited by 170 publications

References 17 publications

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

The potential for emerging therapeutic options forClostridium difficileinfection

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

Contact Info

Product

Resources

About