Antibiotic treatment for Clostridium difficile -associated diarrhoea in adults

Abstract

No firm conclusions can be drawn regarding the efficacy of antibiotic treatment in severe CDI as most studies excluded patients with severe disease. The lack of any 'no treatment' control studies does not allow for any conclusions regarding the need for antibiotic treatment in patients with mild CDI beyond withdrawal of the initiating antibiotic. Nonetheless, moderate quality evidence suggests that vancomycin is superior to metronidazole and fidaxomicin is superior to vancomycin. The differences in effectiveness between these antibiotics were not too large and the advantage of metronidazole is its far lower cost compared to the other two antibiotics. The quality of evidence for teicoplanin is very low. Adequately powered studies are needed to determine if teicoplanin performs as well as the other antibiotics. A trial comparing the two cheapest antibiotics, metronidazole and teicoplanin, would be of interest.

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

“…Metronidazole remains cost effective and readily available. In systematic reviews, there appears to be no difference between metronidazole and vancomycin therapy for initial episodes of CDI . There are concerns regarding possible generation of vancomycin‐resistant enterococci with vancomycin use.…”

Clostridium difficile associated disease

“…Evidence from systematic reviews and meta-analyses suggests that fidaxomicin is better than vancomycin at reducing recurrence 22232425262728293031. Fidaxomicin might therefore be a better treatment option than vancomycin, except for patients with severe infections.…”

“…One review found that sustained symptomatic cure was improved with teicoplanin compared with vancomycin;39 however, the quality of evidence is low, and the drug is not available in the US.…”

Antibiotic Associated Diarrhea in Hospitalized Adult Patien

“…6 The treatment of AAD or CD associated diarhea include non-pharmacologic, pharmacologic including antibiotics (metronidazole, vancomycine, fidaxomicin), probiotics and surgery. 3,[7][8][9][10][11][12] The aims of this study is to know the incidence of AAD, Clostridium difficile infection and other gastrointestinal symptoms in hospitalized adult patients.…”