Treatment of Severe C. difficile–Associated Diarrhea: Vancomycin vs. Metronidazole

Among patients with severe disease, the clinical cure rate was significantly higher with vancomycin than with metronidazole.

Clostridium difficile is the most common cause of nosocomial diarrhea in acute-care settings. Until now, the two available therapies for C. difficile–associated diarrhea (CDAD), vancomycin and metronidazole, had been compared in only two prospective, randomized trials — neither of them blinded or placebo-controlled. Moreover, these studies did not distinguish between mild and severe CDAD.

Now, researchers in Illinois have conducted a single-center, double-blind study in which patients with diarrhea and either C. difficile toxin A in the stool or documented pseudomembranous colitis were randomized to receive vancomycin 125 mg or metronidazole 250 mg, each plus placebo, four times daily. Patients were stratified by CDAD severity, with severe d…

Reviewing Author

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)