Oral vancomycin versus metronidazole for the treatment of Clostridioides difficile infection: Meta-analysis of randomized controlled trials.

Abstract

At present, vancomycin (VCM) and metronidazole (MNZ) are used for the first-line standard treatment of Clostridioides difficile infection (CDI). However, their differential use has not been sufficiently investigated. In this study, a meta-analysis on differences in the efficacy for CDI between VCM and MNZ was performed. Reports of randomized controlled studies using VCM or MNZ to treat CDI were surveyed. Meta-analysis was performed using the Mantel-Haenszel method and random-effects model, and the risk ratio and 95% confidence interval were calculated. Excluding overlapping reports, 1043 reports were extracted and 5 randomized controlled studies were extracted. There was no difference in therapeutic effects for CDI between VCM and MNZ (RR = 1.08, 95% CI (0.99-1.17), p = 0.09, I2 = 37%). On subgroup analysis by the severity, there was no difference in the clinical effects for CDI between VCM and MNZ in non-severe cases (risk ratio: 1.09, 95% confidence interval: 1.00-1.19, p = 0.06), but the clinical effects of VCM were significantly higher than those of MNZ in severe cases (risk ratio: 1.19, 95% confidence interval: 1.02-1.39, p = 0.03). No significant difference was noted in the recurrence rate, incidence of adverse event, time to exhibit therapeutic effects, or judgment of the bacteriological effects. As the therapeutic effects of VCM were superior in severe CDI cases, VCM should be considered first in severe cases.

• Authors: Yuki Igarashi, Sho Tashiro, Yuki Enoki, Kazuaki Taguchi, Kazuaki Matsumoto, Hiroki Ohge, Hiromichi Suzuki, Atsushi Nakamura, Nobuaki Mori, Yoshitomo Morinaga, Yuka Yamagishi, Sadako Yoshizawa, Katsunori Yanagihara, Hiroshige Mikamo, Hiroyuki Kunishima
• Journal: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (J Infect Chemother) Vol. 24 Issue 11 Pg. 907-914 (Nov 2018) ISSN: 1437-7780 [Electronic] Netherlands
• PMID: 30170735 (Publication Type: Comparative Study, Journal Article, Meta-Analysis)
• Copyright: Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Metronidazole
• Vancomycin

Topics

• Administration, Oral
• Anti-Bacterial Agents (therapeutic use)
• Clostridioides difficile (drug effects, isolation & purification)
• Clostridium Infections (diagnosis, drug therapy, microbiology)
• Humans
• Metronidazole (therapeutic use)
• Randomized Controlled Trials as Topic
• Recurrence
• Severity of Illness Index
• Treatment Outcome
• Vancomycin (therapeutic use)