Prospective study of oral teicoplanin versus oral vancomycin for therapy of pseudomembranous colitis and Clostridium difficile-associated diarrhea

Abstract

A prospective, randomized study comparing oral teicoplanin with oral vancomycin in the treatment of pseudomembranous colitis (PMC) and Clostridium djffcile-associated diarrhea (CDAD) was performed.Teicoplanin was administered at a dosage of 100 mg twice a day for 10 days, and vancomycin was administered at a dosage of 500 mg four times a day for 10 days. CDAD was diagnosed by demonstrating both C. dfficile and cytotoxin in the feces of symptomatic patients (more than three loose stools per day). The diagnosis of PMC was also based on colonoscopy. Cytotoxin assay and cultures were checked in all patients 7 to 10 days after discontinuation of therapy and 25 to 30 days thereafter. Of the 51 patients enrolled, 46 were judged to be assessable. Among these, 26 received teicoplanin and 20 received vancomycin. At enrollment, both groups were comparable in terms of age, sex, occurrence of PMC or CDAD, and previous antibiotic treatment. Eighteen of the 20 patients in the vancomycin group and 10 of the 26 patients in the teicoplanin group had previously undergone surgery (P = 0.0004). Treatment resulted in the clinical cure of 20 (100%o) vancomycin and 25 (96.2%) teicoplanin patients (P = 0.56). After discontinuation of therapy, clinical symptoms recurred in four (20%o) vancomycin patients and two (7.7%) teicoplanin patients (P = 0.21). Posttherapy asymptomatic C. difficile carriage (positive follow-up cultures without any clinical symptoms) occurred in five (25%) vancomycin patients and two (7.7%) teicoplanin patients (P = 0.11). Overall, 9 of 20 (45%) vancomycin patients and 5 of 26 (19.2%) teicoplanin patients (P = 0.059) appeared not to be cleared of C. diffcile after treatment. No adverse effects related to vancomycin or teicoplanin therapy were observed.

Review article: treatment of Clostridium difficile infection

“…The most common limitations of trial design included lack of blinding of study participants, and the absence of testing of the adequacy of blinding and allocation concealment. Of the nine included trials four were double-blinded, 14,17,18,21 three trials did not report the blinding status 15,16,20 and two trials were randomized but had no concealment of allocation. 19,22 There was considerable variation in the extent to which the colonic mucosa was assessed in the included trials.…”

“…with either teicoplanin 50 mg q.d.s. 21 or vancomycin 500 mg q.d.s., 20 and one trial directly compared vancomycin, metronidazole, teicoplanin and fusidic acid. 22 The outcome data are summarized in Tables 2 and 3.…”

Oral teicoplanin for successful treatment of severe refractory Clostridium difficile infection

“…Few studies, which analysed the use of oral teicoplanin in the treatment of CDI, showed its success [7,8]. The achieved clinical cure rates were 96% and 96.2%, while recurrence rates were 7% and 7.7% [7,8].…”

“…Intravenous tygecyclin, intravenous immunoglobulins, oral vancomycin in higher doses, and vancomycin enema are some of the suggested treatment regimens but they were all applied to a small number of patients [3][4][5][6]. Oral teicoplanin is another antibiotic, which was proven to be successful in the treatment of patients with CDI, including those with severe disease [7,8]. Previous studies have not analysed the role of teicoplanin in the treatment of refractory disease.…”

Clostridium difficile-Associated Colitis: Role of the Immune Response and Approach to Treatment

“…Treatment for recurrences may follow vancomycin administration in a pulsed regimen (Mc Farland et al, 2002) that allows the germination of spores in between antimicrobial administration to improve efficacy. Other antibiotics, nitazoxanide, teicoplanin and most recently fidaxomicin h a v e b e e n s h o w n t o b e a s e f f e c t i v e a s vancomycin treatment and have been indicated as possible alternative therapies (de Lalla et al, 1992 ;Louie et al;Musher et al, 2009). …”