Factors Associated With Failure of Metronidazole in Clostridium difficile–associated Disease

Abstract

Albumin level <2.5g/l and intensive care unit stay were predictors of failure of metronidazole therapy for C. difficile-associated diarrhea. These patients may benefit from oral vancomycin therapy at outset.

Treatment Strategies for Recurrent Clostridium difficile Infection

“…21,24 One early prospective trial found that metronidazole was noninferior to vancomycin, with cure rates exceeding 90% after treatment of the initial C. difficile infection. 25 However, more recent data, including results for patients with NAP1 infection, have indicated treatment failure rates up to 50% with metronidazole.…”

Alternative treatments for Clostridium difficile disease: what really works?

“…Randomized trials show excellent initial responses in approximately 95 % of patients treated with metronidazole (Teasley et al, 1983;Wenisch et al, 1996). The response rate may be lower in patients who are extremely ill. One study found that 38 % of patients treated with metronidazole had persistent diarrhoea 5 days after metronidazole treatment was begun (Fernandez et al, 2004). Such patients were more likely to have low albumin levels (, 2 .…”

The potential for emerging therapeutic options forClostridium difficileinfection

“…High failure rates for metronidazole, due to the emergence of the outbreak-associated R027 strains and also a rise in the number of elderly patients in hospitals affected by CDI who are already being treated with other antibiotics, have also been reported. 23,24 The treatment for non-epidemic and epidemic C. difficile strains appears to be similar, with metronidazole as the primary treatment choice for mild-moderate cases of CDI, followed by vancomycin for more severe CDI, according to the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines. Fidaxomicin has already been proven to have promising efficacy as a therapeutic for CDI.…”