Oral Vancomycin for Antibiotic-Associated Pseudomembranous Colitis

Tedesco, Francis J.; Gurwith, Marc; Markham, Richard B.; Christie, Dennis L.; Bartlett, John G.

doi:10.1016/s0140-6736(78)91741-5

Cited by 220 publications

(50 citation statements)

References 9 publications

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“…Curiously, the in vitro activity of ampicillin was remarkably similar to that of vancomycin. To our knowledge, there are no reported cases of pseudomembranous colitis due to vancomycin, and this agent has been found to be remarkably effective in the treatment of pseudomembranous colitis (13,17).…”

Section: Resultsmentioning

confidence: 99%

“…It has been noted that a number of patients with pseudomembranous colitis have the onset of VOL. 17,1980 on May 9, 2018 by guest http://aac.asm.org/ Downloaded from diarrhea after the antimicrobial agents have been discontinued (16). This poses the possibility that strains of C. difficile which are relatively susceptible to the implicated agent could propagate at the time of decreased colonic levels (11).…”

Section: Resultsmentioning

confidence: 99%

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In vitro susceptibility of Clostridium difficile isolates from patients with antibiotic-associated diarrhea or colitis

Dzink¹,

Bartlett²

1980

Antimicrob Agents Chemother

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In vitro susceptibility tests were performed on 84 strains of Clostridium difficile to 11 antimicrobial agents. All isolates were from the stools of patients with antibiotic-associated diarrhea or colitis in which there was a cytopathic toxin that was neutralized by Clostridium sordellii antitoxin. Over 95% of the strains were susceptible to vancomycin, penicillin G, ampicillin, and metronidazole at concentrations of 4 jig/ml. Susceptibility to clindamycin was variable; 60% of the strains were susceptible at 1 ,tg/ml, and 9% were' resistant at 128 ,g/ml. Studies of individual isolates showed that a major portion of the strains were relatively susceptible to the antimicrobial agent implicated in causing the disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

In vitro susceptibility of Clostridium difficile isolates from patients with antibiotic-associated diarrhea or colitis

Dzink¹,

Bartlett²

1980

Antimicrob Agents Chemother

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“…Treatment failures occur in 15 to 20% of cases (52). Oral vancomycin is recommended in severe disease or in cases of metronidazole failure (53,54), but it fails to cure in up to 15% of cases (55). Fidaxomicin has just been approved as a third antibiotic for the treatment of CDI, but its global cure rate is only 77% (56).…”

Section: Discussionmentioning

confidence: 99%

MAPK-Activated Protein Kinase 2 Contributes to Clostridium difficile-Associated Inflammation

et al. 2013

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Clostridium difficile infection (CDI) results in toxin-induced epithelial injury and marked intestinal inflammation. Fecal markers of intestinal inflammation correlate with CDI disease severity, but regulation of the inflammatory response is poorly understood. Previous studies demonstrated that C. difficile toxin TcdA activates p38 kinase in tissue culture cells and mouse ilium, resulting in interleukin-8 (IL-8) release. Here, we investigated the role of phosphorylated mitogen-activated protein kinase (MAPK)-activated protein kinase (MK2 kinase, pMK2), a key mediator of p38-dependent inflammation, in CDI. Exposure of cultured intestinal epithelial cells to the C. difficile toxins TcdA and TcdB resulted in p38-dependent MK2 activation. Toxininduced IL-8 and GRO␣ release required MK2 activity. We found that p38 and MK2 are activated in response to other actin-disrupting agents, suggesting that toxin-induced cytoskeleton disruption is the trigger for kinase-dependent cytokine response. Phosphorylated MK2 was detected in the intestines of C. difficile-infected hamsters and mice, demonstrating for the first time that the pathway is activated in infected animals. Furthermore, we found that elevated pMK2 correlated with the presence of toxigenic C. difficile among 100 patient stool samples submitted for C. difficile testing. In conclusion, we find that MK2 kinase is activated by TcdA and TcdB and regulates the expression of proinflammatory cytokines. Activation of p38-MK2 in infected animals and humans suggests that this pathway is a key driver of intestinal inflammation in patients with CDI.

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“…For additional recurrences, a combination of a prolonged taper of the antibiotic with oral vancomycin, followed by pulsed dosing is often used. The original reports of tapered dosing utilized oral vancomycin as the preferred drug, since levels in stool are high, over 1000-fold higher than the level needed to inhibit C. difficile and do not decrease as diarrhea resolves [146] . Early suggested courses were vancomycin 125 mg qid for 7 d, tapering to 125 mg bid for 7 d, then daily for 7 d [147] .…”

Section: Clinical Approach To Recurrent CDImentioning

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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Oral Vancomycin for Antibiotic-Associated Pseudomembranous Colitis

Cited by 220 publications

References 9 publications

In vitro susceptibility of Clostridium difficile isolates from patients with antibiotic-associated diarrhea or colitis

In vitro susceptibility of Clostridium difficile isolates from patients with antibiotic-associated diarrhea or colitis

MAPK-Activated Protein Kinase 2 Contributes to Clostridium difficile-Associated Inflammation

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

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