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In recent years, reports have emerged describing the failure of metronidazole as therapy for Clostridium difficile–associated disease (CDAD). Although the microbiological basis for metronidazole failure in CDAD is unknown, levels of metronidazole in the gastrointestinal tract are much lower than those of vancomycin. Now, in a prospective, observational study partially funded by vancomycin’s manufacturer, researchers in Cleveland have compared the use of these drugs in 52 patients who were diagnosed with CDAD between November 2006 and July 2007.
Of the 34 patients initially treated with metronidazole, 10 (29%) were switched to vancomycin after 3 to 10 days because their symptoms persisted. None of the 18 patients initially treated with vancom…