| Continuation of antibiotics is associated with failure of metronidazole for Clostridium difficile-associated diarrhea. | |
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MedLine Citation:
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PMID: 16340634 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Metronidazole is first-line therapy for C. difficile-associated diarrhea primarily because of its low cost relative to vancomycin. Currently, it is unknown which patients will fail metronidazole therapy. Our goal was to prospectively evaluate risk factors for metronidazole failure. STUDY: Included patients had symptomatic C. difficile-associated diarrhea, either mild or severe. Once enrolled, detailed baseline data were gathered. All interviews were performed daily while the patient was in the hospital for up to 14 days. If discharged prior to 14 days, the patient received a follow-up phone call on day 5 and day 14. Enrolled patients were given a daily stool survey to complete. RESULTS: We enrolled 27 patients with C. difficile-associated diarrhea. All patients (10 of 10) who had their offending antibiotic(s) discontinued had symptomatic resolution of diarrhea by day 14 of metronidazole treatment. Conversely, 59% (10 of 17) of patients who remained on antibiotics during treatment had symptomatic resolution by day 14 (P=0.02). The risk ratio for treatment failure was 2.0 (95% confidence interval, 1.29-3.10) in patients who remained on antibiotics. In our treatment group, there would be one additional metronidazole treatment success for every 2.4 patients who discontinued antibiotics. CONCLUSION: Patients who remain on antibiotics while undergoing treatment of C. difficile-associated diarrhea have a high likelihood of treatment failure with metronidazole. |
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Authors:
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Scott Modena; Satya Gollamudi; Frank Friedenberg |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of clinical gastroenterology Volume: 40 ISSN: 0192-0790 ISO Abbreviation: J. Clin. Gastroenterol. Publication Date: 2006 Jan |
Date Detail:
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Created Date: 2005-12-12 Completed Date: 2006-03-16 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7910017 Medline TA: J Clin Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 49-54 Citation Subset: IM |
Affiliation:
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Section of Gastroenterology, Temple University Hospital, Philadelphia, PA 19140, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Anti-Infective Agents / adverse effects*, therapeutic use* Chi-Square Distribution Clostridium Infections / drug therapy* Clostridium difficile* Diarrhea / drug therapy*, microbiology* Female Humans Interviews as Topic Male Metronidazole / therapeutic use* Middle Aged Prospective Studies Risk Factors Severity of Illness Index Statistics, Nonparametric Treatment Failure |
| Chemical | |
Reg. No./Substance:
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0/Anti-Infective Agents; 443-48-1/Metronidazole |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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