MedicalResearch.com Interview with:
Vanessa W. Stevens, PhD
IDEAS 2.0 Center, Veterans Affairs (VA) Salt Lake City Health Care System
Division of Epidemiology, Department of Internal Medicine
University of Utah School of Medicine
Salt Lake City, Utah
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although metronidazole remains the most commonly used drug to treat Clostridium difficile infection (CDI), there is mounting evidence that vancomycin is a better choice for some patients. Most previous studies have focused on primary clinical cure, but we were interested in downstream outcomes such as disease recurrence and mortality. We found that patients receiving metronidazole and vancomycin had similar rates of recurrence, but patients who were treated with vancomycin had lower risks of all-cause mortality. This was especially true among patients with severe Clostridium difficile.
MedicalResearch.com: What should readers take away from your report?
Response: Instead of immediately reaching for metronidazole, physicians should think about whether the patient has an elevated serum creatinine (>=1.5x baseline), an elevated white blood cell count >= 15 thousand cells per microliter), or complications of Clostridium difficile. These patients are considered to have severe CDI according to SHEA/IDSA criteria and should be treated with vancomycin instead.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: There are some concerns with increasing the use of oral vancomycin over metronidazole for Clostridium difficile. Oral vancomycin, whether branded tablets or compounded from the intravenous formulation, is more expensive than metronidazole. A shift in prescribing could increase the costs of treating CDI. Future research should focus on the cost-effectiveness of various strategies for using vancomycin to treat CDI. Vancomycin resistance is another concern. We need to understand how changing patterns of oral vancomycin use might impact VRE, for example.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Stevens VW, Nelson RE, Schwab-Daugherty EM, Khader K, Jones MM, Brown KA, Greene T, Croft LD, Neuhauser M, Glassman P, Goetz MB, Samore MH, Rubin MA. Comparative Effectiveness of Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With Clostridium difficile Infection. JAMA Intern Med. Published online February 06, 2017. doi:10.1001/jamainternmed.2016.9045
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