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

Treatment Strategies for Recurrent Clostridium difficile Infection

“…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.…”

“…21,24 One early prospective trial found that metronidazole was noninferior to vancomycin, with cure rates exceeding 90% after treatment of the initial C. difficile infection. 25 However, more recent data, including results for patients with NAP1 infection, have indicated treatment failure rates up to 50% with metronidazole.…”

“…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.…”

Critical literature 2007: Clinical topics

“…15 In 94% of metronidazole responders, the score was 2 or less. In 67% of true failures, the score was greater than 2.…”

Fidaxomicin in the treatment of colitis due to Clostridium difficile: preliminary results

“…Questa condizione rappresenta una vera e propria sindrome in costante e importante incremento in tutto il mondo occidentale [5][6][7][8][9]. Le CDI sono: y nella stragrande maggioranza dei casi infezioni nosocomiali di pazienti complessi nei quali aumentano morbilità e mortalità [10][11][12][13][14][15]; y causa di sindromi differenti con coefficienti di gravità diversi [16][17][18][19][20]; …”