PMU-Autor/inn/en
Abstract
In a hospital-based, prospective cohort study, the effects of the three standard treatment regimens for mild Clostridium difficile infection (CDI), oral (p.o.) metronidazole at 500 mg three times/day, intravenous (i.v.) metronidazole at 500 mg three times/day, and oral (p.o.) vancomycin at 250 mg four times/day, were compared with respect to the risk of occurrence of complications, sequelae, and all-cause death within 30 days after the date of starting treatment. Differences in the incidence of these outcomes were tested by χ² or Fisher"s exact tests. A Poisson regression model was performed to control for possible confounding effects of sex, age, and severity of comorbidity categorized according to the Charlson comorbidity index. The highest mortality was observed in the metronidazole i.v. group, with a mortality rate 38.1% (16/42) compared to mortality rates of 7.4% (9/121) in the metronidazole p.o. group and 9.5% (4/42) in the vancomycin p.o. group (P < 0.001). After adjustment for possible effects of sex, age (> 65 years), and severity of comorbidity, the relative risk of a 30-day fatal outcome for patients receiving metronidazole i.v. was 4.3 (95% confidence interval [CI] = 1.92 to 10; P < 0.0001) compared to patients treated with metronidazole p.o. and 4.0 (95% CI = 1.31 to 5.0; P < 0.015) compared to patients treated with vancomycin p.o. There were no significant differences in the risk of complications between the three treatment groups. This study generates the hypothesis that treatment with i.v. metronidazole is inferior to the oral alternatives metronidazole and vancomycin.
Useful keywords (using NLM MeSH Indexing)
Administration, Oral
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Bacterial Agents/administration*
dosage*
Anti-Bacterial Agents/therapeutic use*
Clostridium difficile*
Cohort Studies
Data Interpretation, Statistical
Drug Therapy, Combination
Endpoint Determination
Enterocolitis, Pseudomembranous/drug therapy*
Enterocolitis, Pseudomembranous/microbiology
Enterocolitis, Pseudomembranous/mortality
Feces/microbiology
Female
Humans
Injections, Intravenous
Male
Metronidazole/administration*
dosage*
Metronidazole/therapeutic use*
Middle Aged
Poisson Distribution
Prospective Studies
Risk
Sex Factors
Treatment Outcome
Vancomycin/administration*
dosage*
Vancomycin/therapeutic use*
Young Adult