Metronidazole and Vancomycin Both Perform Well for C. difficile–Associated Diarrhea

Metronidazole and vancomycin are generally thought to be equivalent for the treatment of Clostridium difficile–associated diarrhea (CDAD), although the evidence for this assumption is fairly limited. Chicago researchers now report results from the first blinded, controlled, head-to-head comparison of the two agents.

Over an 8-year period, 172 hospitalized patients with confirmed CDAD were stratified into those with mild disease and those with severe disease (based on a scale including age, temperature, serum albumin, white blood cell count, presence of pseudomembranous colitis on endoscopy, and ICU care). Both groups were separately randomized to receive either oral vancomycin (125 mg 4 times daily) or oral metronidazole (250 mg 4 times dail…