Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: Comparison of two dosage regimens

Fekety, F. Robert; Silva, Joseph; Kauffman, Carol A.; Buggy, Brian P.; Deery, H. Gunner

doi:10.1016/0002-9343(89)90223-4

Cited by 251 publications

(121 citation statements)

References 17 publications

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“…The reason for this difference is not clear and is not related to differences in age, sex, comorbidities or duration of previous anti-microbial therapy (Wenisch, personal communication). 19 When the clinical resolution rates for teicoplanin 200 mg/day were compared to teicoplanin 800 mg/day, no signi®cant difference was detected P 0X168.…”

Section: ±33mentioning

confidence: 94%

“…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. Some trials did not report any investigation, whereas others employed a range of modalities, including proctoscopy, rigid sigmoidoscopy,¯exible sigmoidoscopy, colonoscopy and barium enema.…”

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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Section: ±33mentioning

confidence: 94%

Section: Quality Assessmentmentioning

confidence: 99%

Review article: treatment of Clostridium difficile infection

Zimmerman

Bak

Sutherland

1997

Aliment Pharmacol Ther

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“…No differences in initial cure or recurrence rates were seen in a randomized trial comparing 500 mg and 2 g daily doses of vancomycin (Fekety et al, 1989). Vancomycin has no systemic adsorption and few reported side effects, except for rash (which is common).…”

Section: Vancomycinmentioning

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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“…As a result, it has become common practice to use higher doses of vancomycin if patients are failing to respond to the standard recommended dose of 125 mg four times daily. A trial of 46 patients randomized to 500 or 125 mg of vancomycin four times daily for the initial treatment of CDI showed no diff erence in duration of diarrhea, relapse rate, or microbiological cure (carriage of C. diffi cile at the end of therapy) ( 56 ). Moreover, fecal levels of vancomycin in patients with CDI with this dose achieve levels that are a minimum of 10 times the minimal inhibitory concentration reported for C. diffi cile strains ( 57 ).…”

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confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,477

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: Comparison of two dosage regimens

Abstract: Since the dose of 125 mg appeared to be as effective as the 500-mg dose, which is more expensive, the 125-mg dose is preferred when vancomycin is used in treatment of this disease, unless the patient is critically ill.

Cited by 251 publications

References 17 publications

Review article: treatment of Clostridium difficile infection

Review article: treatment of Clostridium difficile infection

Alternative treatments for Clostridium difficile disease: what really works?

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

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