Korean J Med.  2007 Jun;72(6):639-646.

Therapeutic efficacy of metronidazole for patients with Clostridium difficile-associated diarrhea

• Cheong HS
• Kim JK
• Lim TK
• Kwon KT
• Ryu SY
• Heo ST
• Ko KS
• Oh WS
• Peck KR
• Lee NY
• Song JH

Abstract

BACKGROUDN: The rate of treatment failure with metronidazole for C. difficile-associated diarrhea (CDAD) has been recently increasing in Western countries. A retrospective study was performed to evaluate the clinical outcome of metronidazole treatment and determine the risk factors for treatment failure for patients with CDAD in Korea.
METHODS
From January 2000 to May 2005, patients who had shown a positive result for C. difficile toxin A assay in feces were considered for the study. Patients who had diarrhea and one or more symptoms of fever, abdominal pain or leukocytosis after 48 hours of hospitalization were included. The medical records of the patients and laboratory data were reviewed.
RESULTS
A total of 476 patients (mean age, 56.7 years old) were enrolled in the study. Of these, 382 patients (80.3%) were treated with metronidazole as an initial regimen for CDAD; 316 patients (82.7%) received successful treatment within 14 days, 29 patients (6.3%) had persistent symptoms and signs of colitis and 37 patients (9.7%) had a recurrence of symptoms and signs within 4 weeks after completion of treatment. There were no significant differences in the rates of treatment success for each 5-year period (p>0.05). Among 66 patients who failed to respond to an initial course of metronidazole, 48 patients underwent prolonged or additional courses of metronidazole treatment. Of these, 34 patients (70.8%) were successfully treated. By multivariate analysis, severe diarrhea (p=0.02), prior use of fluroquinolones (p=0.02) and enteral tube feeding (p=0.02) were the risk factors for treatment failure of CDAD with metronidazole.
CONCLUSIONS
Contrary to a recent survey in Western countries, metronidazole is still useful as a primary regimen for the treatment of patients with CDAD in our institution. In CDAD patients with tube feeding, severe diarrhea or the prior use of quinolones, precautions for treatment failure should be taken.

Keyword

Clostridium difficile; Diarrhea; Metronidazole; Fluoroquinolones

MeSH Terms

Abdominal Pain
Clostridium difficile
Clostridium*
Colitis
Diarrhea*
Enteral Nutrition
Feces
Fever
Fluoroquinolones
Hospitalization
Humans
Korea
Leukocytosis
Medical Records
Metronidazole*
Multivariate Analysis
Quinolones
Recurrence
Retrospective Studies
Risk Factors
Treatment Failure
Fluoroquinolones
Metronidazole
Quinolones