| Therapeutic efficacy of metronidazole for patients with Clostridium difficile-associated diarrhea |
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Hae Suk Cheong, Jong Kyu Kim, Tae Kyu Lim, Ki Tae Kwon, Seong Yeol Ryu, Sang Taek Heo, Kwan Soo Ko, Won Sup Oh, Kyong Ran Peck, Nam Yong Lee, Jae Hoon Song |
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고려대학교 의과대학 내과학교실 |
| 원저 : Clostridium difficile 연관 설사에 대한 metronidazole의 치료효과 |
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정혜숙, Jong Kyu Kim, Tae Kyu Lim, Ki Tae Kwon, Seong Yeol Ryu, Sang Taek Heo, Kwan Soo Ko, Won Sup Oh, Kyong Ran Peck, Nam Yong Lee, Jae Hoon Song |
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| Abstract |
Background : The rate of treatment failure with metronidazole for C. difficile-associated diarrhea (CDAD) has been recently increasing in Western countries. A retrospective study was performed to evaluate the clinical outcome of metronidazole treatment and determine the risk factors for treatment failure for patients with CDAD in Korea.
Methods
: From January 2000 to May 2005, patients who had shown a positive result for C. difficile toxin A assay in feces were considered for the study. Patients who had diarrhea and one or more symptoms of fever, abdominal pain or leukocytosis after 48 hours of hospitalization were included. The medical records of the patients and laboratory data were reviewed.
Results
: A total of 476 patients (mean age, 56.7 years old) were enrolled in the study. Of these, 382 patients (80.3%) were treated with metronidazole as an initial regimen for CDAD; 316 patients (82.7%) received successful treatment within 14 days, 29 patients (6.3%) had persistent symptoms and signs of colitis and 37 patients (9.7%) had a recurrence of symptoms and signs within 4 weeks after completion of treatment.
There were no significant differences in the rates of treatment success for each 5-year period (p>0.05). Among 66 patients who failed to respond to an initial course of metronidazole, 48 patients underwent prolonged or additional courses of metronidazole treatment. Of these, 34 patients (70.8%) were successfully treated. By multivariate analysis, severe diarrhea (p=0.02), prior use of fluroquinolones (p=0.02) and enteral tube feeding (p=0.02) were the risk factors for treatment failure of CDAD with metronidazole.
Conclusions
: Contrary to a recent survey in Western countries, metronidazole is still useful as a primary regimen for the treatment of patients with CDAD in our institution. In CDAD patients with tube feeding, severe diarrhea or the prior use of quinolones, precautions for treatment failure should be taken.(Korean J Med 72:639-646, 2007)
Key Words : Clostridium difficile, Diarrhea, Metronidazole, Fluoroquinolones |
| Key Words:
Clostridium difficile, Diarrhea, Metronidazole, Fluoroquinolones |
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