Routinely prescribed antibiotic may not be best severe C. diff treatment

Switching from using metronidazole to vancomycin as the initial treatment for severe Clostridium difficile infections could have a significant effect on mortality rates, according to a study published in JAMA Internal Medicine.

Current guidelines recommend using either metronidazole or vancomycin to treat C. diff infections.

"For many years the two antibiotics were considered to be equivalent in their ability to cure C. diff and prevent recurrent disease," said Vanessa Stevens, PhD, the study's lead author. "Our work and several other studies show that this isn't always the case."

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For this study, researchers examined data from more than 10,000 patients treated for C. diff infections through the Department of Veterans Affairs healthcare system between 2005 and 2012. They defined an infection as severe if the patient had an elevated white blood cell count or serum creatinine within four days of the diagnosis. About 35 percent of cases in this study were severe.

They found no differences in the risk of C. diff recurrence between patients treated with vancomycin and those treated with metronidazole. However, patients with severe C. diff who were treated with vancomycin were less likely to die than those treated with metronidazole.

"The risk of 30-day mortality was significantly reduced among patients who received vancomycin," the study concludes. "Our findings may further justify the use of vancomycin as initial therapy for severe CDI [C. diff infection]."

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