1. Potential impact of removing metronidazole from treatment armamentarium of mild acute Clostridioides difficile infection.
- Author
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Zilberman-Itskovich S, Youngster I, Lazarovitch T, Bondarenco M, Toledano L, Kachlon Y, Mengesha B, Strul N, Zaidenstein R, and Marchaim D
- Subjects
- Acute Disease therapy, Adult, Aged, Aged, 80 and over, Clostridioides difficile drug effects, Clostridium Infections mortality, Female, Humans, Israel, Male, Middle Aged, Practice Guidelines as Topic, Retrospective Studies, Time Factors, Treatment Outcome, Vancomycin pharmacology, Vancomycin therapeutic use, Vancomycin-Resistant Enterococci drug effects, Young Adult, Anti-Bacterial Agents therapeutic use, Clostridium Infections drug therapy, Drug Administration Schedule, Metronidazole therapeutic use
- Abstract
Aim: Recent guidelines recommended removing metronidazole as a therapeutic option for Clostridioides difficile infections (CDI). However, superiority of vancomycin over metronidazole in mild CDI is not established and use of vancomycin might lead to emergence of vancomycin-resistant enterococci (VRE). Patients & methods: A retrospective cohort study and efficacy analyses were conducted at Shamir Medical Center, Israel (2010-2015), among adults with acute CDI. Results: A total of 409 patients were enrolled. In multivariable analyses, metronidazole was noninferior to vancomycin for mild CDI, but vancomycin was an independent predictor for post-CDI VRE acquisition. Conclusion: A significant independent association was evident between treatment with vancomycin and, later, acquisition of VRE. In first episodes of mild acute CDI, metronidazole should be considered a valid therapeutic option.
- Published
- 2019
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