Antibiotic treatment forClostridium difficile-associated diarrhea in adults

Abstract

Current evidence leads to uncertainty whether mild CDAD needs to be treated. The studies provide little evidence for antibiotic treatment of severe CDAD as many studies excluded these patients. Considering the two goals of therapy: improvement of the patient's clinical condition and prevention of spread of C. difficile infection to other patients, one should choose the antibiotic that brings both symptomatic cure and bacteriologic cure. A recommendation to achieve these goals cannot be made because of the small numbers of patients in the included studies and the high risk of bias in these studies, especially related to dropouts. Most of the active comparator studies found no statistically significant difference in efficacy between vancomycin and other antibiotics including metronidazole, fusidic acid, nitazoxanide or rifaximin. Teicoplanin may be an attractive choice but for its limited availability (Teicoplanin is not available in the USA) and great cost relative to the other options. More research of antibiotic treatment and other treatment modalities of CDAD is required.

Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations

“…The only concern from this high-dose antibiotic therapy was the possibility of other complications such as Clostridium difficile colitis. 41,42 However, not a single case of such a complication was reported from the treatment group. Other common adverse side-effects such as diarrhoea, loose stools, nausea, headache, joint pain and rashes were reported from 11% of our patients taking the PARC treatment.…”

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

“…The same can be said for 2013 and the foreseeable future. The recent Cochrane Collaboration review of antibiotic treatment for CDI vividly illustrates the ongoing problems related to treatment decisions [79,80] . The authors reviewed randomized, controlled trials of antibiotic therapy for CDI.…”

Abordaje multidisciplinario de la infección por Clostridium difficile

“…Una revisión Cochrane concluye que teicoplanina es significativamente superior a vancomicina en respuesta bacteriológica inicial (62% vancomicina y 87% teicoplanina) y cura bacteriológica (45% vancomicina y 87% teicoplanina) en el análisis de dos estudios que incluían un total de 110 pacientes. Estos resultados deben ser interpretados con cautela debido al pequeño tamaño de la muestra y la posibilidad de sesgo del análisis conjunto 92 . Por otra parte, teicoplanina es más cara que vancomicina (coste tratamiento/día vancomicina 125 mg/6h: 5 €, teicoplanina 100 mg/12 h: 28 €) pero dispone de un régimen posológico más cómodo.…”