Treatment of Clostridium difficile colitis and diarrhea with vancomycin

Silva, J.; Batts, Donald H.; Fekety, Robert; Plouffe, Joseph F.; Rifkin, Gary D.; Baird, Ian M.

doi:10.1016/0002-9343(81)90369-7

Cited by 75 publications

(29 citation statements)

References 29 publications

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“…Infortunadamente, no se pudo establecer la tasa de recaídas de la enfermedad. La recomendación general, dada la similar reacción clínica a los dos tratamientos (36,37), es tratar las formas leves a moderadas de la enfermedad con metronidazol y dejar la vancomicina para las formas graves, pues ha habido un incremento en la proporción de pacientes que no mejoran con metronidazol y que tienen mayor porcentaje de recaídas (16,17). Vale la pena anotar que en Colombia, al igual que en gran parte de América Latina, la presentación más accesible de la vancomicina es la solución inyectable (21).…”

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Clinical and demographic profile and risk factors for Clostridium difficile infection

Carvajal¹,

Pacheco²,

Jaimes³

2017

biomedica

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Contribución de los autores:Todos los autores participaron en igual medida en todos los aspectos del estudio y la redacción del manuscrito. Introducción. La enfermedad asociada a Clostridium difficile es la principal causa de diarrea infecciosa adquirida en el hospital; su creciente incidencia, las menores tasas de respuesta al tratamiento inicial y la mayor tasa de recaídas han incrementado la carga de la enfermedad. Objetivo. Determinar las características clínicas de los pacientes hospitalizados con enfermedad asociada a C. difficile. Materiales y métodos. Se hizo un estudio de casos anidado en una cohorte. Se revisaron las historias clínicas de pacientes con diarrea iniciada durante su hospitalización a quienes se les había practicado la prueba de detección de la toxina A-B de C. difficile, entre febrero de 2010 y febrero de 2012. Se definió como caso al paciente hospitalizado con diarrea y prueba de Enzyme Linked Fluorescent Assay (ELFA) positiva para la toxina y, como control, a aquel con resultado negativo para la toxina. Se recolectaron los datos demográficos y clínicos, así como la información sobre los factores asociados, la estancia hospitalaria, el tratamiento y las complicaciones. Perfil clínico y demográfico y factores de riesgo frente a la infección por Clostridium difficileResultados. Durante el periodo de seguimiento se recolectaron datos de 123 pacientes, de los cuales 30 fueron positivos para la toxina. La edad media en la población de estudio fue de 49 años y el 60 % correspondía a hombres. Los síntomas predominantes fueron el dolor abdominal (35 %) y la fiebre (34 %). Las principales complicaciones fueron la alteración electrolítica y la sepsis grave asociada con disfunción renal. La mortalidad total fue de 13 % y los factores independientes asociados con la aparición de la infección fueron el uso de inhibidores de la bomba de protones y la cirugía gastrointestinal previa. Conclusiones. El uso de inhibidores de la bomba de protonesy la cirugía gastrointestinal previa fueron factores asociados con la infección por C. difficile. Clinical and demographic profile and risk factors for Clostridium difficile infectionIntroduction: Clostridium difficile infection is the leading cause of nosocomial infectious diarrhea. The increasing incidence added to a lower rate of response to the initial treatment and higher rates of relapse has generated a higher burden of the disease. Objective: To determine the clinical characteristics of hospitalized patients with C. difficile infection. Materials and methods:We made a nested case-cohort study. We reviewed medical records of the patients with nosocomial diarrhea for whom an assay for toxin A-B of C. difficile had been requested from February, 2010, to February, 2012. We defined case as a patient with diarrhea and a positive assay for the toxin, and control as those patients with a negative assay for the toxin. We collected data on demographic and clinical characteristics, risk factors, hospital length of stay, treatment, and complications. Results: We collec...

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Section: Discussionunclassified

Clinical and demographic profile and risk factors for Clostridium difficile infection

Carvajal¹,

Pacheco²,

Jaimes³

2017

biomedica

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“…Oral vancomycin and metronidazole are the recognized therapeutic agents (6,10,11). In addition, oral bacitracin has recently been investigated with variable success (3, 13).…”

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confidence: 99%

“…Antimicrobial therapy directed at C. difficile is indicated in severe disease or in the setting of multiple relapses. Oral vancomycin is considered by some to be the drug of choice (6,10). Metronidazole has been shown to have efficacy equal to that of vancomycin in mild-to-moderate disease (11).…”

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confidence: 99%

In vitro synergy studies with Clostridium difficile

Bacon

McGrath

Fekety

et al. 1991

Antimicrob Agents Chemother

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Agar dilution anaerobic susceptibility studies using rifampin, vancomycin, metronidazole, and bacitracin individually and in combination were performed with Clostridium difficile. Fifty-five strains of C. difficile were studied. Eighty-five percent of strains tested (29 of 34) were synergistically inhibited by the combination of bacitracin and rifampin (fractional inhibitory concentration, .0.50).Antimicrobial therapy is indicated in patients with Clostridium difficile-associated disease who do not respond to appropriate nonspecific treatment or have severe progressive disease. Oral vancomycin and metronidazole are the recognized therapeutic agents (6,10,11). In addition, oral bacitracin has recently been investigated with variable success (3, 13). Despite optimal therapy, up to 20% of patients develop relapses of diarrhea. Prompt repopulation of the gut with "normal flora" is considered the ideal goal by many, and therapeutic instillation of normal flora organisms has been proposed by some investigators (12).The use of combination therapy with vancomycin and rifampin in patients with multiple relapses has shown some promise (1). In vitro studies of synergy of antibiotic combinations with C. difficile are lacking. We evaluated the in vitro activities of bacitracin, vancomycin, and metronidazole alone and in combination with rifampin against C. difficile. Rifampin is a very active antimicrobial agent against C. difficile, with excellent inhibitory activity (7).(This study was presented in abstract form at the 1990 annual meeting of the American Society for Microbiology, Anaheim, Calif.) C. difficile strains were isolated on CCFA agar from stool specimens of patients (2) Individual-drug MIC plates were run with each synergy test. Aerobic contamination, anaerobic growth control, and uninoculated sterile plates were included with each run, as were the control organisms. Determinations of all MICs for representative strains and combination testing were performed in duplicate. Antimicrobial interaction was quantified according to the fractional inhibitory concentration (FIC) and FIC index.The FIC index was interpreted as follows: c0.5, full synergy; 0.51 to 0.75, partial synergy; and 0.76 to 1.25, additivity (4, 8). Table 1 shows the MICs of each of the antimicrobial agents tested. All 55 strains tested were susceptible to rifampin at an MIC of 0.002 ,ug/ml or less. Almost 90% were inhibited at a concentration of 0.001 ,ug/ml. Vancomycin susceptibility data revealed all 47 strains to be susceptible at or below 1.6 ,ug/ml. Metronidazole MICs were from 0.8 to 3.2 ,ug/ml. All 34 strains tested were susceptible to bacitracin at or below 32 U/ml. Only 44% of our isolates were susceptible to bacitracin at an MIC of 16 U/ml.The results of synergy studies are shown in

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“…difficile isolates are highly susceptible in vitro to many antimicrobial agents, including vancomycin, metronidazole, bacitracin, rifampin (13), and amoxycillin-clavulanic acid (6), and several studies document the effectiveness of oral vancomycin (12,16,24,28), metronidazole (8,27), and bacitracin (29). Generally, vancomycin is considered the drug of choice for the treatment of PMC (11,19,24,28), with metronidazole and bacitracin as useful alternatives (22). Recently, in clinical situations in which enteral therapy has not been possible, intravenous metronidazole has been advocated (20).…”

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confidence: 99%

“…The clinical response to vancomycin treatment is usually very good and prompt, with a reduction in severity of diarrhea within 48 to 72 h (12). Relapse after vancomycin therapy has, however, been reported in 14 to 20% of patients (4,12,24), and posttreatment asymptomatic carriage of C. difficile is even more common, occurring in as many as 28% of patients (12). Teicoplanin, a new glycopeptide antibiotic, is very active in vitro against C. difficile isolates (22,23).…”

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Treatment of Clostridium difficile-associated disease with teicoplanin

Lalla

Privitera

Rinaldi

et al. 1989

Antimicrob Agents Chemother

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Forty-seven patients affected by Clostridium difficile-associated disease were treated orally with either vancomycin (patients hospitalized from February 1984 to February 1987) or teicoplanin (from March 1987 to December 1988). All patients given teicoplanin remained asymptomatic after discontinuation of treatment, and all but one were also cleared of C. difficile. In the vancomycin group, clinical symptoms recurred in 3 of 23 evaluable patients, and follow-up cultures were positive in another asymptomatic case.

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Treatment of Clostridium difficile colitis and diarrhea with vancomycin

Cited by 75 publications

References 29 publications

Clinical and demographic profile and risk factors for Clostridium difficile infection

Clinical and demographic profile and risk factors for Clostridium difficile infection

In vitro synergy studies with Clostridium difficile

Treatment of Clostridium difficile-associated disease with teicoplanin

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