Routinely Prescribed Antibiotics Not Effective for Treating Severe Clostridium Difficile Infections

Highlights

Clostridium difficile infections may not be treated using routinely prescribed antibiotics.
The infection is less likely to die due to vancomycin when compared to metronidazole.
Future research work is required to understand the targeted applications of vancomycin in severe Clostridium difficile infections.

Most routinely prescribed antibiotics may not be a best treatment option for the severity of infections caused by the bacteria Clostridium difficile (C. diff).

A research team from the VA Salt Lake City Health Care System and University of Utah reports that patients with severe Clostridium difficile infection (CDI) are less likely to die due to vancomycin when compared to metronidazole treatment.

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‘Routinely prescribed antibiotics like vancomycin and metronidazole may not be effective in the treatment of Clostridium difficile infections.’

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The research findings were published online in the Journal of the American Medical Association (JAMA).

According to the Centers for Disease Control and Prevention (CDC) report, half a million Americans who were mostly 65 or older, were found to develop CDI in 2011.

Around 83,000 patients were found to experience recurrence of infection within 30 days of completing the course of antibiotics.

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Vanessa Stevens, Ph.D., research assistant professor in the department of internal medicine and investigator at IDEAS 2.0 Center at the VA, said, "This is a very real problem that impacts the patients' quality of life."

The study also showed that there is up to a 20% chance of mortality within 30 days of CDI diagnosis.

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Mechanism of How Clostridium difficile Works

The C.difficile bacteria may produce two chemicals which are toxic to the human body. These toxins were found to irritate the cells of the intestinal lining and may produce symptoms associated with illness.

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Symptoms of Clostridium difficile Infections

Watery diarrhea
Fever
Loss of Appetite
Nausea
Abdominal pain and tenderness

Severe cases may also result in colon inflammation

The current guidelines were found to recommend two antibiotics vancomycin and metronidazole, for the treatment of Clostridium difficile infections. Vancomycin is the original treatment for infections, however the medical community has favored the use of metronidazole which is less expensive and limits the resistance of vancomycin infections which is responsible for other hospital-acquired infections.

Stevens, said, "For many years the two antibiotics were considered to be equivalent in their ability to cure C. diff and prevent recurrent disease."

"Our work and several other studies show that this isn't always the case."

The effectiveness of the two drugs by comparing the risk of mortality after treatment with these two antibiotics were also discussed in the current issue of the JAMA Internal Medicine.

Research Study
The research team examined the data from more than 10,000 patients who were treated for Clostridium difficile infections through the US Department of Veterans Affairs healthcare system from 2005-2012.

Severe infection of Clostridium difficile with an elevated white blood cell count or serum creatinine within four days of CDI diagnosis.

Mild to moderate case of CDI is defined when the patients have normal white blood cell counts and creatinine levels. 35% of these cases were found to be severe.

The results of the report found that patients who had a severe case of CDI were found to have a lower mortality rate with vancomycin when compared to metronidazole.

Only 25 patients with severe CDI would need to be treated with vancomycin to prevent death.

Stevens, explains, "That is a powerful, positive outcome for our patient's well-being," She also cautioned that the researchers have not yet understood on how to choose the antibiotic that affects the mortality rates.

Micheal Rubin, M.D., Ph.D., associate professor of internal medicine and an investigator at the VA Salt Lake City Health Care System, said, "Although antibiotics are one of the greatest miracles of modern medicine, there are still tremendous gaps in our knowledge about when and how to use them to give our patients the best health outcomes."

Rubin, said, "This research shows that if providers choose vancomycin over metronidazole to treat patients with severe CDI, it should result in a lower risk of death for those critically ill patients."

The study also showed that less than 15 percent of CDI patients which also included severe cases, were found to receive vancomycin.

The results of the study also did not show any difference in the illness rate nor the number of deaths after antibiotic treatment.

Limitations of the Study

Study was observational in nature
Did not prove the cause and effect of the drug
Focused primarily on men

The author finally concludes that future work should balance the application of vancomycin treatment especially for Clostridium difficile infections. The best way to decide the treatment will be decisional analysis which weighs both the pros and cons of the treatment.

Source-Medindia