Soonchunhyang Med Sci.  2018 Jun;24(1):28-33. 10.0000/sms.2018.24.1.28.

Preserved Efficacy of Oral Metronidazole for Severe Clostridium difficile Infection

Affiliations
  • 1Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
  • 2Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea. shegets@schmc.ac.kr

Abstract


OBJECTIVE
Although clinical practice guidelines recommend oral vancomycin for hospitalized patients with severe Clostridium difficile infection (CDI), oral metronidazole is still the preferred regimen due to its tolerability and low cost. In this study, we aimed to compare the clinical efficacy based on clinical cure, recurrence, and 30-day mortality of oral metronidazole and oral vancomycin in treating severe CDI.
METHODS
The medical records of patients with the diagnosis of severe CDI in a tertiary hospital in South Korea, between June, 2006 and December, 2013, were analyzed.
RESULTS
A total of 162 severe CDI patients were enrolled for this study: 139 received oral metronidazole and 23 received oral vancomycin. The rate of clinical cure was not significantly different between treatments (79.86% for oral metronidazole and 82.61% for oral vancomycin, P>0.99). The rate of recurrence was comparable (20.77% vs. 18.18% for metronidazole and vancomycin, respectively; P>0.99), as was the rate of 30-day mortality (9.35% vs. 4.35%, P=0.69). Risk factors for treatment failure were histamine-2 antagonist treatment (odds ratio [OR], 4.34; 95% confidence interval [CI], 1.64-11.51; P=0.0032) and fever (OR, 2.43; 95% CI, 1.0-5.8; P=0.049).
CONCLUSION
The clinical efficacy of oral metronidazole for severe CDI was no difference from oral vancomycin, in a real world setting. Oral metronidazole can be a reasonable option for treating severe CDI.

Keyword

Clostridium infection; Metronidazole; Vancomycin

MeSH Terms

Clostridium difficile*
Clostridium Infections
Clostridium*
Diagnosis
Fever
Humans
Korea
Medical Records
Metronidazole*
Mortality
Recurrence
Risk Factors
Tertiary Care Centers
Treatment Failure
Treatment Outcome
Vancomycin
Metronidazole
Vancomycin
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