J C O'Horo1, K Jindai, B Kunzer, N Safdar. 1. Section of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND: Clostridium difficile infection (CDI) recurs in nearly one-third of patients who develop an initial infection. Recurrent CDI (RCDI) is associated with considerable morbidity, mortality, and cost. Treatment for RCDI has not been not well examined. METHODS: A systematic review. RESULTS: Sixty-four articles were identified evaluating eight different treatment approaches: metronidazole, vancomycin, fidaxomicin, nitazoxanide, rifampin, immunoglobulins, probiotics, and fecal bacteriotherapy. The meta-analysis found vancomycin to have a similar efficacy to metronidazole, although studies used varying doses and durations of therapy. Fidaxomicin was slightly more efficacious than vancomycin, though the number of studies was small. Good evidence for probiotics was limited. Fecal bacteriotherapy was found to be highly efficacious in a single randomized trial. CONCLUSION: Metronidazole and vancomycin have good evidence for use in RCDI but heterogeneity in treatment duration and dose precludes robust conclusions. Fidaxomicin may have a role in treatment, but evidence is limited to subgroup analyses. Fecal bacteriotherapy was the most efficacious. Saccharomyces boulardii may have a role as adjunctive treatment.
BACKGROUND:Clostridium difficileinfection (CDI) recurs in nearly one-third of patients who develop an initial infection. Recurrent CDI (RCDI) is associated with considerable morbidity, mortality, and cost. Treatment for RCDI has not been not well examined. METHODS: A systematic review. RESULTS: Sixty-four articles were identified evaluating eight different treatment approaches: metronidazole, vancomycin, fidaxomicin, nitazoxanide, rifampin, immunoglobulins, probiotics, and fecal bacteriotherapy. The meta-analysis found vancomycin to have a similar efficacy to metronidazole, although studies used varying doses and durations of therapy. Fidaxomicin was slightly more efficacious than vancomycin, though the number of studies was small. Good evidence for probiotics was limited. Fecal bacteriotherapy was found to be highly efficacious in a single randomized trial. CONCLUSION:Metronidazole and vancomycin have good evidence for use in RCDI but heterogeneity in treatment duration and dose precludes robust conclusions. Fidaxomicin may have a role in treatment, but evidence is limited to subgroup analyses. Fecal bacteriotherapy was the most efficacious. Saccharomyces boulardii may have a role as adjunctive treatment.
Authors: P Patrick Basu; Amreen Dinani; Krishna Rayapudi; Tommy Pacana; Niraj James Shah; Hemant Hampole; N V Krishnaswamy; Vinod Mohan Journal: Therap Adv Gastroenterol Date: 2010-07 Impact factor: 4.409
Authors: Thomas J Louie; Jennifer Peppe; C Kevin Watt; David Johnson; Rasheed Mohammed; Gordon Dow; Karl Weiss; Stuart Simon; Joseph F John; Gary Garber; Scott Chasan-Taber; David M Davidson Journal: Clin Infect Dis Date: 2006-07-11 Impact factor: 9.079
Authors: Daniel M Musher; Nancy Logan; Vaibhav Mehendiratta; Nicolas A Melgarejo; Sagar Garud; Richard J Hamill Journal: J Antimicrob Chemother Date: 2007-03-02 Impact factor: 5.790
Authors: Kelsey Shields; Roger V Araujo-Castillo; Thimmaiah G Theethira; Carolyn D Alonso; Ciaran P Kelly Journal: Anaerobe Date: 2015-04-27 Impact factor: 3.331
Authors: Massimo Sartelli; Mark A Malangoni; Fikri M Abu-Zidan; Ewen A Griffiths; Stefano Di Bella; Lynne V McFarland; Ian Eltringham; Vishal G Shelat; George C Velmahos; Ciarán P Kelly; Sahil Khanna; Zaid M Abdelsattar; Layan Alrahmani; Luca Ansaloni; Goran Augustin; Miklosh Bala; Frédéric Barbut; Offir Ben-Ishay; Aneel Bhangu; Walter L Biffl; Stephen M Brecher; Adrián Camacho-Ortiz; Miguel A Caínzos; Laura A Canterbury; Fausto Catena; Shirley Chan; Jill R Cherry-Bukowiec; Jesse Clanton; Federico Coccolini; Maria Elena Cocuz; Raul Coimbra; Charles H Cook; Yunfeng Cui; Jacek Czepiel; Koray Das; Zaza Demetrashvili; Isidoro Di Carlo; Salomone Di Saverio; Irina Magdalena Dumitru; Catherine Eckert; Christian Eckmann; Edward H Eiland; Mushira Abdulaziz Enani; Mario Faro; Paula Ferrada; Joseph Derek Forrester; Gustavo P Fraga; Jean Louis Frossard; Rita Galeiras; Wagih Ghnnam; Carlos Augusto Gomes; Venkata Gorrepati; Mohamed Hassan Ahmed; Torsten Herzog; Felicia Humphrey; Jae Il Kim; Arda Isik; Rao Ivatury; Yeong Yeh Lee; Paul Juang; Luis Furuya-Kanamori; Aleksandar Karamarkovic; Peter K Kim; Yoram Kluger; Wen Chien Ko; Francis D LaBarbera; Jae Gil Lee; Ari Leppaniemi; Varut Lohsiriwat; Sanjay Marwah; John E Mazuski; Gokhan Metan; Ernest E Moore; Frederick Alan Moore; Carl Erik Nord; Carlos A Ordoñez; Gerson Alves Pereira Júnior; Nicola Petrosillo; Francisco Portela; Basant K Puri; Arnab Ray; Mansoor Raza; Miran Rems; Boris E Sakakushev; Gabriele Sganga; Patrizia Spigaglia; David B Stewart; Pierre Tattevin; Jean Francois Timsit; Kathleen B To; Cristian Tranà; Waldemar Uhl; Libor Urbánek; Harry van Goor; Angela Vassallo; Jean Ralph Zahar; Emanuele Caproli; Pierluigi Viale Journal: World J Emerg Surg Date: 2015-08-20 Impact factor: 5.469