Antibiotic-associated colitis due to Clostridium difficile: Double-blind comparison of vancomycin with bacitracin

Young, Graeme P.; Ward, Peter; Bayley, Noel; Gordon, David B.; Higgins, G.; Trapani, Joseph A.; McDonald, Malcolm; LaBrooy, Justin T.; Hecker, Robert

doi:10.1016/0016-5085(85)90206-9

Cited by 159 publications

(58 citation statements)

References 29 publications

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“…Two trials compared bacitracin to vancomycin (Young et al, 1985;Dudley et al, 1986). No significant difference in initial cure rates was seen (Table 1).…”

Section: Bacitracinmentioning

confidence: 99%

“…per day) or placebo for 28 days combined with vancomycin or metronidazole in various 0 0·5 1·0 2·0 4·0 6·0 Relative risk Wenisch et al (1996) Teicoplanin vs. Young et al (1985) Bacitracin vs. Vancomycin Teasley et al (1983) Metronidazole vs. Vancomycin Alternative treatments for Clostridium difficile doses as selected by the participating physician (McFarland et al, 1994). The recurrence rate in patients with recurrent CDAD was 35 % for the S. boulardii group compared to 65 % for the placebo group (P ¼ 0 .…”

Section: Probioticsmentioning

confidence: 99%

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Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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Vancomycin and metronidazole have been used for treating Clostridium difficile-associated disease (CDAD) for the past 25 years, but approximately 20 % of patients develop recurrent disease. The increasing incidence of nosocomial outbreaks, cases of recurrent CDAD and other complications (toxic megacolon, ileus, sepsis) has fuelled the search for different types of treatments. As the understanding of the pathogenesis of this disease has matured, newer treatment strategies that take advantage of these mechanisms have been developed. This review will describe such treatments and examine the evidence for each strategy.

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“…Two trials compared bacitracin to vancomycin (Young et al, 1985;Dudley et al, 1986). No significant difference in initial cure rates was seen (Table 1).…”

Section: Bacitracinmentioning

confidence: 99%

Section: Probioticsmentioning

confidence: 99%

Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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“…In two trials the proportion of patients who had a clinical improvement within 24±72 h of stopping antibiotics ranged from 23 to 75%. 16,17 The patients reported in these two trials thus represent a group with relatively refractory C. dif®cile disease. The other included' studies did not report this`washout' period, and may have included patients who would have undergone spontaneous resolution of their C. dif®cile infection.…”

Section: ±46mentioning

confidence: 99%

“…16, 18±20 Two trials compared vancomycin with bacitracin, 17,18 two trials compared teicoplanin 100 mg b.d. with either teicoplanin 50 mg q.d.s.…”

Section: Search Strategymentioning

confidence: 99%

“…The most common limitations of trial design included lack of blinding of study participants, and the absence of testing of the adequacy of blinding and allocation concealment. Of the nine included trials four were double-blinded, 14,17,18,21 three trials did not report the blinding status 15,16,20 and two trials were randomized but had no concealment of allocation. 19,22 There was considerable variation in the extent to which the colonic mucosa was assessed in the included trials.…”

Section: Quality Assessmentmentioning

confidence: 99%

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Review article: treatment of Clostridium difficile infection

Zimmerman

Bak

Sutherland

1997

Aliment Pharmacol Ther

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Aim:A systematic review of controlled trials of therapy of Clostridium difficile intestinal infection using methodology described by the Cochrane Collaboration.Methods:Trials were identified by searching computer databases over the years 1978–1996. Trials were included if they were (a) prospective randomized, controlled trials and (b) included patients with symptomatic disease. The primary end‐point was clinical resolution of diarrhoea. Secondary end‐points were clinical relapse and stool clearance of C. difficile and C. difficile toxin.Results:Nine trials (469 patients) satisfying the inclusion criteria were identified. Two trials were placebo controlled. Six trials compared vancomycin to other antibiotics (fusidic acid, bacitracin, teicoplanin and metronidazole). For clinical resolution response rates ranged from 21 (placebo) to 100% (vancomycin). On pooling the trials, no antibiotic showed clear therapeutic superiority. Rates of clinical relapse ranged from 5 to 42%. Only one trial showed significant advantage of one antibiotic over another for prevention of relapse (teicoplanin vs. fusidic acid).Conclusion:The published data are limited, and further studies are required.

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Clostridium difficile–Associated Diarrhea

Mylonakis¹,

Ryan²,

Calderwood³

2001

Arch Intern Med

311

211

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Clostridium difficile causes 300 000 to 3 000 000 cases of diarrhea and colitis in the United States every year. Antibiotics most frequently associated with the infection are clindamycin, ampicillin, amoxicillin, and cephalosporins, but all antibiotics may predispose patients to C difficile infection. The clinical presentation varies from asymptomatic colonization to mild diarrhea to severe debilitating disease, with high fever, severe abdominal pain, paralytic ileus, colonic dilation (or megacolon), or even perforation. The most sensitive and specific test available for diagnosis of C difficile infection is a tissue culture assay for the cytotoxicity of toxin B. However, this test takes 1 to 3 days to complete and requires tissue culture facilities. Detection of C difficile toxin by means of enzyme-linked immunoassay is more rapid and inexpensive. A minority of patients may require more than 1 stool assay to detect toxin. Oral metronidazole or oral vancomycin hydrochloride for 10 to 14 days are equally effective at resolving clinical symptoms; oral metronidazole is preferred in most cases because of lowered cost and less selective pressure for vancomycin-resistant organisms. Approximately 15% of patients experience relapse after initial therapy and require retreatment, sometimes with an extended, tapering regimen. Immunity appears to be incomplete and predominantly mediated by serum IgG to toxin A. Measures for preventing the spread of the pathogen, appropriate diagnostic testing, and treatment may avert morbidity and mortality due to C difficile-associated diarrhea.

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Antibiotic-associated colitis due to Clostridium difficile: Double-blind comparison of vancomycin with bacitracin

Cited by 159 publications

References 29 publications

Alternative treatments for Clostridium difficile disease: what really works?

Alternative treatments for Clostridium difficile disease: what really works?

Review article: treatment of Clostridium difficile infection

Clostridium difficile–Associated Diarrhea

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