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Antibiotic treatment for Clostridium difficile-associated diarrhea in adults

  1. Richard L Nelson1,*,
  2. Philippa Kelsey2,
  3. Hayley Leeman2,
  4. Naomi Meardon2,
  5. Haymesh Patel2,
  6. Kim Paul2,
  7. Richard Rees2,
  8. Ben Taylor2,
  9. Elizabeth Wood2,
  10. Rexanna Malakun3

Editorial Group: Cochrane IBD Group

Published Online: 7 SEP 2011

Assessed as up-to-date: 12 OCT 2010

DOI: 10.1002/14651858.CD004610.pub4


How to Cite

Nelson RL, Kelsey P, Leeman H, Meardon N, Patel H, Paul K, Rees R, Taylor B, Wood E, Malakun R. Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD004610. DOI: 10.1002/14651858.CD004610.pub4.

Author Information

  1. 1

    Northern General Hospital, Department of General Surgery, Sheffield, Yorkshire, UK

  2. 2

    University of Sheffield, The Medical School, Sheffield, UK

  3. 3

    University of Sheffield, School of Medicine and Biomedical Sciences, Sheffield, UK

*Richard L Nelson, Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, Yorkshire, S5 7AU, UK. altohorn@btinternet.com. Rick.Nelson@sth.nhs.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 7 SEP 2011

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Anonymous 1994 {published data only}
  • Anonymous. Treatment of Clostridium difficile associated diarrhea and colitis with an oral preparation of teicoplanin; a dose finding study. The Swedish CDAD Study Group. Scandinavian Journal of Infectious Diseases 1994;26(3):309-16. [PUBMED: 7939431]
Boero 1990 {published data only}
  • Boero M, Berti E, Morgando A, Verme G. Treatment of pseudomembranous colitis: a randomized controlled trial with rifaximin vs vancomycin [Terapia della colite da Clostridium difficile: risultati di uno studio randomizzato aperto rifaximina vs. vancomicina]. Microbiologia Medica 1990;5(2):74-7.
de Lalla 1992 {published data only}
  • de Lalla F, Nicolin R, Rinaldi E, Scarpellini P, Rigoli R, Manfrin V, et al. Prospective study of oral teicoplanin versus oral vancomycin for therapy of pseudomembranous colitis and Clostridium difficile-associated diarrhea. Antimicrobial Agents and Chemotherapy 1992;36(10):2192-6. [PUBMED: 1444298]
Dudley 1986 {published data only}
  • Dudley MN, McLaughlin JC, Carrington G, Frick J, Nightingale CH, Quintiliani R. Oral bacitracin vs vancomycin therapy for Clostridium difficile-induced diarrhea. A randomized double-blind trial. Archives of Internal Medicine 1986;146(6):1101-4. [PUBMED: 3521518]
Fekety 1989 {published data only}
  • Fekety R, Silva J, Kauffman C, Buggy B, Deery HG. Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. American Journal of Medicine 1989;86(1):15-9. [PUBMED: 2910090]
Keighley 1978 {published data only}
  • Keighley MR, Burdon DW, Arabi Y, Williams JA, Thompson H, Youngs D, et al. Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea. British Medical Journal 1978;2(6153):1667-9. [PUBMED: 367509]
Lagrotteria 2006 {published data only}
  • Lagrottereria D, Holmes S, Smieja M, Smaill F, Lee C. Prospective, randomized inpatient study of oral metronidazole versus oral metronidazole and rifampin for treatment of primary episode of Clostridium difficile-associated diarrhea. Clinical Infectious Diseases 2006;43(5):547-52. [PUBMED: 16886144]
Louie 2009 {published data only}
  • Louie T, Miller M, Donskey C, Mullane K, Goldstein EJ. Clinical outcomes, safety and pharmacokinetics of OPT-80 in a phase 2 trial with patients with Clostridium difficile infection. Antimicrobial Agents and Chemotherapy 2009;53(1):223-8. [PUBMED: 18955525]
Musher 2006 {published data only}
  • Musher DM, Logan N, Hamill RJ, Dupont HL, Lentnek A, Gupta A, et al. Nitazoxanide for the treatment of Clostridium difficule colitis. Clinical Infectious Diseases 2006;43(4):421-7. [PUBMED: 16838229]
Musher 2009 {published data only}
  • Musher DM, Logan N, Bressler AM, Johnson DP, Rossignol JF. Nitazoxanide versus vancomycin in Clostridium difficile infection: a randomized, double-blind study. Clinical Infectious Diseases 2009;48(4):e41-6. [PUBMED: 19133801]
Teasley 1983 {published data only}
  • Teasley DG, Gerding DN, Olson MM, Peterson LR, Gebhard RL, Schwartz MJ, et al. Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet 1983;2(8358):1043-6. [PUBMED: 6138597]
Wenisch 1996 {published data only}
  • Wenisch C, Parschalk B, Hasenhundl M, Hirschl AM, Graninger W. Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea. Clinical Infectious Diseases 1996;22(5):813-8. [PUBMED: 8722937]
Wullt 2004 {published data only}
  • Wullt M, Odenholt I. A double-blind randomized controlled trial of fusidic acid and metronidazole for treatment of an initial episode of Clostridium difficile-associated diarrhoea. Journal of Antimicrobial Chemotherapy 2004;54(1):211-6. [PUBMED: 15163651]
Young 1985 {published data only}
  • Young GP, Ward PB, Bayley N, Gordon D, Higgins G, Trapani JA, et al. Antibiotic-associated colitis due to Clostridium difficile: double-blind comparison of vancomycin with bacitracin. Gastroenterology 1985;89(5):1038-45. [PUBMED: 4043661]
Zar 2007 {published and unpublished data}
  • Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A Comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clinical Infectious Diseases 2007;45(3):302-7. [PUBMED: 17599306]

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Johnson 1992 {published data only}
  • Johnson S, Homann SR, Bettin KM, Quick JN, Clabots CR, Peterson LR, et al. Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial. Annals of Internal Medicine 1992;117(4):297-302. [PUBMED: 1322075]
Louie 2006 {published data only}
  • Louie TJ, Peppe J, Watt CK, Johnson D, Mohammed R, Dow G, et al. Tolevamer, a novel nonantibiotic polymer, compared with vancomycin in the treatment of mild to moderately severe Clostridium difficile-associated diarrhea. Clinical Infectious Diseases 2006;43(4):411-20. [PUBMED: 16838228]
Lowy 2010 {published data only}
  • Lowy I, Molrine DC, Leav BA, Blair BM, Baxter R, Gerding DN, et al. Treatment with monoclonal antibodies against clostridium difficile toxins. New England Journal of Medicine 2010;362(3):197-205. [PUBMED: 20089970]
Mattila 2008 {published data only}
  • Mattila E, Anttila VJ, Broas M, Marttila H, Poukka P, Kuusisto K, et al. A randomized, double-blind study comparing Clostridium difficile immune whey and metronidazole for recurrent Clostridium difficile-associated diarrhoea: efficacy and safety of a prematurely interrupted trial. Scandinavian Journal of Infectious Diseases 2008;40(9):702-8. [PUBMED: 19086244]
McFarland 2002 {published data only}
  • McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. American Journal of Gastroenterology 2002;97(7):1769-75. [PUBMED: 12135033]
    Direct Link:
Noren 2006 {published data only}
  • Noren T, Wullt M, Akerlund T, Back E, Odenholt I, Burman LG. Frequent emergence of resistance in Clostridium difficile during treatment of C. difficile-associated diarrhea with fusidic acid. Antimicrobial Agents and Chemotherapy 2006;50(9):3028-32. [PUBMED: 16940098]
Numan 2007 {published data only}
  • Numan SC, Veldkamp P, Kuijper EJ, van den Berg RJ, van Dissel JT. Clostridium difficile-associated diarrhoea: bovine anti-Clostridium difficile whey protein to help aid the prevention of relapses. Gut 2007;56(6):888-9. [PUBMED: 17519495]

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Assmann 2000
Baker 2002
  • Baker SG, Kramer BS. The transitive fallacy for randomized trials: if A bests B and B bests C in separate trials, is A better than C?. BMC Medical Research Methodology 2002;2:13.
Bartlett 1980
  • Bartlett JG, Taylor NS, Chang T, Dzink J. Clinical and laboratory observations in Clostridium difficile colitis. American Journal of Clinical Nutrition 1980;33(11 Suppl):2521-6.
Bartlett 1990
Bartlett 2002
Bauer 2009
Bishara 2007
BNF 2004
  • Joint Formulary Committee. British National Formulary. 7th Edition. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2004.
Bowden 1981
  • Bowden TA Jr, Mansberger AR Jr, Lykins LE. Pseudomembranous enterocolitis: mechanism for restoring floral homeostasis. American Surgeon 1981;47(4):178-83.
Cohen 2010
  • Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilkox MH. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update for the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infection Control and Hospital Epidemiology 2010;31(5):431-55.
Fekety 1993
Fekety 1997
  • Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. American Journal of Gastroenterology 1997;92(5):739-50.
George 1982
  • George WL, Rolfe RD, Finegold SM. Clostridium difficile and its cytotoxin in feces of patients with antimicrobial agent-associated diarrhea and miscellaneous conditions. Journal of Clinical Microbiology 1982;15(6):1049-53.
Gerding 1995
Higgins 2008
  • Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies.. In: Higgins JPT, Green S, editors(s) editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
Ho 1996
  • Ho M, Yang D, Wyle FA, Mulligan ME. Increased incidence of Clostridium difficile-associated diarrhea following decreased restriction of antibiotic use. Clinical Infectious Diseases 1996;23 Suppl 1:S102-6.
Hopkins 2009
  • Johns Hopkins. Teicoplanin. www.hopkins-abxguide.org/antibiotics/antibacterial/glycopeptide/teicoplanin.html?contentInstanceId=254836 2009.
HPA 2008
  • Health Protection Agency of the Department of Health, UK. Clostridium difficile infection: How to deal with the problem. hpa.org.uk 2008, issue 12.
HPA 2010
  • Health Protection Agency. Summary Points on Clostridium difficile infection (CDI). www.hpa.org.uk/web/HPAwebfile/HPAweb_C/1278944283388 2010.
Karas 2010
Kelly 1994
Khoruts 2010
  • Khoruts A, Dicksved J, Jansson JK, Sadowsky MJ. Changes in the composition of the human fecal microbiome after bacteriotherapy for recurrent Clostridium difficile-associated diarrhea. Journal of Clinical Gastroenterology 2010;44(5):354-60.
Lai 1997
  • Lai KK, Melvin ZS, Menard MJ, Kotilainen HR, Baker S. Clostridium difficile-associated diarrhea: epidemiology, risk factors, and infection control. Infection Control and Hospital Epidemiology 1997;18(9):628-32.
Laurence 2006
  • Laurence J. Deaths from "dirty hospital bug" double in five years. The Independant 26 May, 2006:11.
Louie 2005
Manian 1995
McDonald 2005
  • McDonald LC, Killgore GE, Thompson A, Owens RC Jr, Kazakova SV, Sambol SP, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. New England Journal of Medicine 2005;353(23):2433-41.
McFarland 1995
  • McFarland LV, Surawicz CM, Greenberg RN, Elmer GW, Moyer KA, Melcher SA, et al. Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo. American Journal of Gastroenterology 1995;90(3):439-48.
McFarland 1999
  • McFarland LV, Surawicz CM, Rubin M, Fekety R, Elmer GW, Greenberg RN. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infection Control and Hospital Epidemiology 1999;20(1):43-50.
Morris 2002
  • Morris AM, Jobe BA, Stoney M, Sheppard BC, Deveney CW, Deveney KE. Clostridium difficile colitis: an increasingly aggressive iatrogenic disease?. Archives of Surgery 2002;137(10):1096-100.
Mosby 2003
  • Mosby. Mosby's Drug Consult 2004, 14th Edition. St. Louis, MO: Mosby, 2003.
Novell 2010
Olson 1994
  • Olson MM, Shanholtzer CJ, Lee JT Jr, Gerding DN. Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infection Control and Hospital Epidemiology 1994;15(6):371-81.
Pepin 2005
  • Pepin J, Valiquette L, Cossette B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. Canadian Medical Association Journal 2005;173(9):1037-42.
Pindera 2004
Privitera 1991
  • Privitera G, Scarpellini P, Ortisi G, Nicastro G, Nicolin R, de Lalla F. Prosepctive study of Clostridium difficile intestinal colonization and disease following single-dose antibiotic prophylaxis in surgery. Antimicrobial Agents and Chemotherapy 1991;35(1):208-10.
Redelings 2007
Rubin 1995
Sougioultzis 2005
  • Sougioultzis S, Kyne L, Drudy D, Keates S, Maroo S, Pothoulakis C, et al. Clostridium difficile toxoid vaccine in recurrent C. difficile-associated diarrhea. Gastroenterology 2005;128(3):764-70.
Thomas 2003
  • Thomas C, Stevenson M, Riley TV. Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review. Journal of Antimicrobial Chemotherapy 2003;51(6):1339-50.