A prospective observational study comparing three different treatment regimes in patients with Clostridium difficile infection.

Link to article at PubMed

A prospective observational study comparing three different treatment regimes in patients with Clostridium difficile infection.

Antimicrob Agents Chemother. 2012 Jan 17;

Authors: Wenisch JM, Schmid D, Kuo HW, Allerberger F, Michl V, Tesik P, Tucek G, Laferl H, Wenisch C

Abstract
ObjectiveTo test the effects of the three standard treatment regimens for mild Clostridium difficile infection (CDI) on the risk of complications, sequelae and all-cause death within 30 days after starting treatment.MethodsIn a hospital-based, prospective cohort study the three standard treatment regimens of oral (p.o.) metronidazole 3 × 500 mg/d, intravenous (i.v.) metronidazole 3 × 500 mg/d and oral (p.o.) vancomycin 4 × 250 mg/d, for mild CDI were compared with respect to occurrence of complications, sequelae and all-cause death within 30 days after date of starting treatment. Differences in the incidence of these outcomes were tested by ?2 or Fisher's exact tests. A Poisson regression model was performed to control for possible confounding effects of sex, age and severity of comorbidity categorized according to the Charlson comorbidity index.ResultsThe highest mortality was observed in the metronidazole i.v. group with 38.1% (16/42) compared to 7.4% (9/121) in the metronidazole p.o. group and 9.5% (4/42) in the vancomycin p.o. group (p<0.001). After adjustment for possible effects of sex, age (> 65 years) and severity of comorbidity, the relative risk of 30-day fatal outcome for patients receiving metronidazole i.v. was 4.3 (95%CI 1.92-10; p<0.0001) as compared to patients with metronidazole p.o. and 4.0 (95%CI: 1.31-5.0; p<0.015) compared to patients treated with vancomycin p.o. There were no significant differences in the risk of complications between the three treatment groups.ConclusionThis study generates the hypothesis that treatment with i.v. metronidazole is inferior to the oral alternatives metronidazole and vancomycin.

PMID: 22252830 [PubMed - as supplied by publisher]

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