Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea.

Keighley, M. R. B.; Burdon, D. W.; Arabi, Y.; Williams, J.; Thompson, Helen; Youngs, Denise; Johnson, Margaret M.; Bentley, Sandra; George, R.H.; Mogg, G. A. G.

doi:10.1136/bmj.2.6153.1667

Cited by 240 publications

(56 citation statements)

References 8 publications

(1 reference statement)

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“…16, 17, 20±22 Neither of the placebo-controlled trials reported any surveillance for any adverse effects. 14,15 In the studies that reported laboratory monitoring of the patients, no adverse biochemical or haematological abnormalities were attributed to any of the interventions studied. Of the 469 patients studied, only three patients were reported to be intolerant of the treatment medication (one patient intolerant of teicoplanin, one intolerant of vancomycin and one of metronidazole).…”

Section: Secondary End-pointðtoxicity and Adverse Effectsmentioning

confidence: 99%

“…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.…”

Section: Quality Assessmentmentioning

confidence: 99%

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Review article: treatment of Clostridium difficile infection

Zimmerman

Bak

Sutherland

1997

Aliment Pharmacol Ther

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Aim:A systematic review of controlled trials of therapy of Clostridium difficile intestinal infection using methodology described by the Cochrane Collaboration.Methods:Trials were identified by searching computer databases over the years 1978–1996. Trials were included if they were (a) prospective randomized, controlled trials and (b) included patients with symptomatic disease. The primary end‐point was clinical resolution of diarrhoea. Secondary end‐points were clinical relapse and stool clearance of C. difficile and C. difficile toxin.Results:Nine trials (469 patients) satisfying the inclusion criteria were identified. Two trials were placebo controlled. Six trials compared vancomycin to other antibiotics (fusidic acid, bacitracin, teicoplanin and metronidazole). For clinical resolution response rates ranged from 21 (placebo) to 100% (vancomycin). On pooling the trials, no antibiotic showed clear therapeutic superiority. Rates of clinical relapse ranged from 5 to 42%. Only one trial showed significant advantage of one antibiotic over another for prevention of relapse (teicoplanin vs. fusidic acid).Conclusion:The published data are limited, and further studies are required.

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Section: Secondary End-pointðtoxicity and Adverse Effectsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Review article: treatment of Clostridium difficile infection

Zimmerman

Bak

Sutherland

1997

Aliment Pharmacol Ther

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“…In May 1978, a third study [39] reported that C. difficile was responsible for PMC and that previous antibiotic therapy produces susceptibility to infection, presumably as a result of a change in the bacterial flora. Finally, in late 1978, it was demonstrated that vancomycin eliminates toxin-producing C. difficile from the colon and is associated with rapid clinical improvement in patients with pseudomembranous colitis [40]. Fig.…”

Section: Clostridium Difficile Discovery and Its Early History In Humansmentioning

confidence: 99%

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Rodríguez

Broeck

Taminiau

et al. 2016

Microbial Pathogenesis

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a b s t r a c tRecognised as the leading cause of nosocomial antibiotic-associated diarrhoea, the incidence of Clostridium difficile infection (CDI) remains high despite efforts to improve prevention and reduce the spread of the bacterium in healthcare settings. In the last decade, many studies have focused on the epidemiology and rapid diagnosis of CDI. In addition, different typing methods have been developed for epidemiological studies. This review explores the history of C. difficile and the current scope of the infection. The variety of available laboratory tests for CDI diagnosis and strain typing methods are also examined.

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“…Vancomycin given in doses of 0.5 to 2.0 g per day has been shown to be effective in producing symptomatic improvement and a decrease in the titers of toxin in stool (5,8). The use of anion-exchange resins, such as cholestyramine, which bind the toxin appears to be efficacious in some cases, but the results are not as dramatic as those produced by vancomycin (5,11).…”

mentioning

confidence: 93%

Analysis of the in vitro interaction between vancomycin and cholestyramine

King¹,

Barriere²

1981

Antimicrob Agents Chemother

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Vancomycin and cholestyramine have been utilized both alone and in combination for the treatment of antibiotic-associated pseudomembranous colitis. Previous work has demonstrated significant binding of vancomycin by the anionexchange resin. The antibacterial activity of vancomycin was markedly reduced when the suspension was centrifuged and the supernatant was tested for antibacterial activity. This study confirmed these findings but demonstrated that there was no immediate loss of antibacterial activity of bound vancomycin. The degree of inactivation appeared to be dependent upon the duration of incubation of vancomycin and cholestyramine in the testing system. Antibiotic-associated pseudomembranous colitis (PMC) has been linked to the presence of Clostridium difficile within the colonic flora of patients with the disease. The organism elaborates a cytotoxin which is capable of producing the lesions found in PMC (1, 2, 5).Many cases of PMC may be self-limited if the offending agent is withdrawn; however, treatment with orally administered vancomycin or cholestyramine may be necessary. Vancomycin given in doses of 0.5 to 2.0 g per day has been shown to be effective in producing symptomatic improvement and a decrease in the titers of toxin in stool (5,8). The use of anion-exchange resins, such as cholestyramine, which bind the toxin appears to be efficacious in some cases, but the results are not as dramatic as those produced by vancomycin (5, 11).Several reports of relapse of PMC after oral vancomycin therapy have been noted and have led some authorities to suggest that the use of vancomycin plus cholestyramine or other antibiotics active against C. difficile might provide superior therapy (3, 6). However, potential difficulties arise with the combination since it has been demonstrated that vancomycin is approximately 90% bound by cholestyramine (4, 10).Although the presence of vancomycin does not inhibit binding of the cytotoxin by the resin, the concentration of vancomycin present is sharply reduced (4). These studies have examined the concentration of unbound vancomycin in the supernatant of centrifuged specimens.To our knowledge, the activity of bound van-comycin has not been examined. The purpose of this study was to examine the effects of cholestyramine binding of vancomycin in centrifuged and uncentrifuged samples. cholestyramine usually given within 24 h (2,000 mg and 12 g, respectively) were each mixed in 1 liter of the buffered saline. Five sets of mixtures were examined as follows: A, vancomycin (2 mg/ml); B, cholestyramine suspension (12 mg/ml); and C, D, and E, vancomycin (2 mg/ml) plus cholestyramine (12 mg/ ml). Each solution was tested in triplicate. All of the tubes were agitated in a water bath at 37°C for 45 min and then centrifuged for 15 min. Samples of the supernatant from A, B, and C were then immediately decanted and assayed for vancomycin activity. Tubes in D were blended with a Vortex mixer after centrifugation to resuspend the cholestyramine, and samples of the suspension were assayed ...

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Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea.

Cited by 240 publications

References 8 publications

Review article: treatment of Clostridium difficile infection

Review article: treatment of Clostridium difficile infection

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Analysis of the in vitro interaction between vancomycin and cholestyramine

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