Higher Risk Of Recurrence And Death From Clostridium difficile Infection After Initial Therapy With Metronidazole
D Scheurer, J Ross
clostridium difficile, death, metronidazole, recurrence, treatment, vancomycin
D Scheurer, J Ross. Higher Risk Of Recurrence And Death From Clostridium difficile Infection After Initial Therapy With Metronidazole. The Internet Journal of Gastroenterology. 2006 Volume 5 Number 2.
It is controversial whether initial therapy of Clostridium difficile colitis with metronidazole is associated with higher rates of recurrence or death, compared to vancomycin. In this retrospective cohort of 1309 hospitalized patients, patients had a higher risk of recurrence and death with metronidazole therapy compared to vancomycin therapy (14% vs. 7%, p<0.025 for recurrence; 18% vs. 11%, p<.05 for death).
Recent reports suggest that the incidence and severity of
Despite data showing therapeutic equivalency of vancomycin and metronidazole in
A retrospective cohort was identified of all patients at Brigham and Women's Hospital hospitalized between 1997 and 2004 with an ICD9 diagnosis for
There were a total of 1016 individual subjects with a
Of the total cohort, 127 (12%) experienced a recurrence, and 170 (17%) died. For patients initially treated with metronidazole or vancomycin, the recurrence rates were 7% and 14% respectively (p<0.025) and death rates were 11% and 18% respectively (p<0.05) (Table 2). Of the 127 patients that had a recurrence, 116 were treated with flagyl and 11 were treated with vancomycin; of those treated with metronidazole, 26 died (23%) versus none of the vancomycin treated patients (p=0.10).
This study was limited by its single institution design, but as a large urban teaching hospital, our population of patients should be generalizable to many other patient populations. The use of ICD9 codes in identifying patients could also be a limitation of the study, although 2 previous studies, including one from this institution, showed that ICD9 coding for
In conclusion, this data supports other recent observational studies that the use of metronidazole as first-line treatment in patients with
This study was not funded and there is no conflict of interest to report from either author.