Intravenous metronidazole for the treatment of Clostridium difficile colitis

Friedenberg, Frank K.; Fernandez, Angel; Kaul, Vivek; Niami, Pardis; Levine, Gary M.

doi:10.1007/bf02234641

Cited by 63 publications

(23 citation statements)

References 18 publications

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“…9 %) this route was effective (Apisarnthanarak et al, 2002). Several case reports, and an observational study in 10 patients, suggest that the intravenous route of metronidazole may be effective for patients with paralytic ileus or toxic megacolon (Friedenberg et al, 2001).…”

Section: Treatment Of Complicationsmentioning

confidence: 97%

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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Section: Treatment Of Complicationsmentioning

confidence: 97%

Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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“…Administration of metronidazole intravenously or administration of vancomycin by nasogastric tube or rectal enema has been described in small case series. 57,71,80,81 Intravenous administration of vancomycin is not recommended because the drug is not excreted into the colon. 57 Intravenous immunoglobulin therapy has been used with success in a small number of patients with fulminant disease.…”

Section: Treatmentmentioning

confidence: 99%

Clostridium difficile-associated diarrhea in adults

Poutanen

Simor²

2004

Canadian Medical Association Journal

360

280

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CLOSTRIDIUM DIFFICILE is the most important cause of nosocomial diarrhea in adults. Illness may range from mild watery diarrhea to life-threatening colitis. An antecedent disruption of the normal colonic flora followed by exposure to a toxigenic strain of C. difficile are necessary first steps in the pathogenesis of disease. Diagnosis is based primarily on the detection of C. difficile toxin A or toxin B. First-line treatment is with oral metronidazole therapy. Treatment with oral vancomycin therapy should be reserved for patients who have contraindications or intolerance to metronidazole or who fail to respond to first-line therapy

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“…Bolton and Culshaw [44] measured fecal concentrations of metronidazole in patients who received oral or IV therapy for acute CDAD and found that adequate concentrations of the drug were found in the watery stools of patients treated by either route. A recent retrospective study examined 10 patients who had received IV metronidazole for C. difficile colitis [45]. The investigators found that the symptoms of vomiting, fever, and abdominal pain resolved in a majority of treated patients, but unfortunately the resolution of diarrhea was not evaluated.…”

Section: Treatment Of Primary Infectionmentioning

confidence: 99%

Clostridium difficile — associated diarrhea: Current strategies for diagnosis and therapy

Moyenuddin

Williamson

Ohl

2002

Curr Gastroenterol Rep

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Clostridium difficile, a spore-forming toxigenic bacterium, is one of the most common causes of infectious diarrhea and colitis in the United States. Most patients with C. difficile infection have recently received antimicrobial therapy--usually clindamycin, cephalosporins, or the extended-spectrum penicillins. Clinical presentation varies from asymptomatic colonization to mild diarrhea to severe colitis. The mainstay of diagnosis is detection of C. difficile toxin A, toxin B, or both with a cytotoxin test or enzyme immunoassay of the stool of patients who have received antibiotic therapy and have features of C. difficile-associated diarrhea. Enzyme immunoassays that detect both toxins are preferred because of their higher diagnostic accuracy. If the first assay is negative and C. difficile-associated diarrhea is strongly suspected, a second assay may be performed. Ten days of oral metronidazole is the preferred therapy for most initial infections. Vancomycin is considered second-line therapy because of its cost and potential to select for vancomycin resistance. About 20% to 25% of patients experience reinfection or relapse after initial therapy and require retreatment. The disease can best be prevented by limiting the use of broad-spectrum antibiotics and adhering to control techniques.

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Intravenous metronidazole for the treatment of Clostridium difficile colitis

Abstract: Intravenous metronidazole may be effective therapy in patients with C. difficile colitis. A randomized, prospective study appears warranted.

Cited by 63 publications

References 18 publications

Alternative treatments for Clostridium difficile disease: what really works?

Alternative treatments for Clostridium difficile disease: what really works?

Clostridium difficile-associated diarrhea in adults

Clostridium difficile — associated diarrhea: Current strategies for diagnosis and therapy

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