Vanco or Metronidazole for Severe C Difficile?

A recently-published study in JAMA suggests that Clostridium difficile may be more effectively treated with vancomycin than its more commonly used counterpart metronidazole.

Although guidelines recommend both vancomycin and metronidazole, health care professionals typically favor the latter treatment due to its cost-effectiveness and a desire to limit vancomycin resistance in other hospital-acquired infections.

Researchers at the VA Salt Lake City Health Care System and University of Utah School examined the risk of mortality after treatment with both antibiotics. They examined data from more than 10,000 patients treated for C difficile from 2005 to 2012 through the US Department of Veteran Affairs health care system. About 35% of cases evaluated in the study were considered severe, which is defined by elevated white blood cell count or serum creatinine within 4 days of C difficile diagnosis.

Overall, patients with severe cases were less likely to die when treated with vancomycin compared to metronidazole. Scientists determined that only 1 patient with a severe case of C difficile would need to be treated with vancomycin to prevent 1 death. Despite the results, the researchers still lack understanding as to why one antibiotic works more effectively over the other. The study results also did not demonstrate a difference gap in rates of recurrent C difficile followed by treatment, nor did it demonstrate a difference in mortality rates for mild to moderate cases.

The researchers noted that the study was limited in that it was observational and therefore does not provide a definitive cause and effect relationship. Additionally, the study focused on primarily patients who were men, although previous studies demonstrated similar treatment outcomes for both men and women with C difficile. Future research should weigh various treatment strategies for severe cases in regards to economic considerations and antibiotic resistance concerns, according to the study.

Reference

Routinely Prescribed Antibiotic May Not Be Best for Treating Severe C. diff Infections [news release]. Utah. University of Utah’s website. http://healthcare.utah.edu/publicaffairs/news/2017/02/Stevens-Cdiff.php. Accessed Feb. 6, 2017.