Korean J Clin Pharm.  2017 Jun;27(2):77-82. 10.24304/kjcp.2017.27.2.77.

A Comparison of Vancomycin and Metronidazole for the Treatment of Clostridium difficile-associated Diarrhea (CDAD) in Medical Intensive Care Unit (MICU)

• Cho EA
• Lee KA
• Kim JS
• Kim SH
• Son ES

• KMID: 2387587
• DOI: http://doi.org/10.24304/kjcp.2017.27.2.77

Abstract

BACKGROUND
Clostridium difficile associated diarrhea (CDAD) is a leading cause of hospital-associated gastrointestinal illness. Risk factors for CDAD include advanced age, long-term admission, antibiotics, proton-pump inhibitor or Hâ‚‚ blocker use and immunosuppression. The practice guideline of American Journal of Gastroenterology (2013) suggests metronidazole for the first-line therapy of mild-moderate CDAD as well as vancomycin for severe CDAD. MICU inpatients receiving stress ulcer prophylaxis and antibiotics are susceptible to nosocomial CDAD. Therefore, this study aimed to evaluate occurrence and treatment of CDAD in MICU.
METHODS
Patients who were admitted to the MICU and had CDAD from August 2012 to August 2015 were analyzed retrospectively.
RESULTS
Of the 90 patients with CDAD, 20 patients (2.22%) had mild-moderate CDAD (16 received metronidazole and 4 received vancomycin therapy) and 70 patients (77.8%) had severe CDAD(54 received metronidazole and 16 received vancomycin therapy). Among the patients with mild-moderate CDAD, treatment with metronidazole or vancomycin resulted in same clinical cure in 50% of the patients (p=1.00). Among the patients with severe CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 40.7% and 50.0% of the patients, respectively (p=0.511). Clinical symptoms recurred in 7.4% of the severe CDAD patients treated with metronidazole and 6.3% of those treated with vancomycin (p=0.875).
CONCLUSION
Our findings suggest that metronidazole and vancomycin are equally effective for the treatment of mild-moderate CDAD; however, vancomycin demonstrated higher clinical cure rate and lower recurrence rate for severe CDAD, although the difference was not statistically significant. For better clinical outcomes, appropriate medication use by disease severity is needed.

Keyword

Clostridium difficile associated diarrhea; metronidazole; vancomycin; medical intensive care unit (micu)

MeSH Terms

Anti-Bacterial Agents
Clostridium difficile
Clostridium*
Critical Care*
Diarrhea*
Gastroenterology
Humans
Immunosuppression
Inpatients
Intensive Care Units*
Metronidazole*
Recurrence
Retrospective Studies
Risk Factors
Ulcer
Vancomycin*
Anti-Bacterial Agents
Metronidazole
Vancomycin