title: Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole.
abstract: BACKGROUND
  Clostridium difficile is a frequent cause of serious nosocomial infection. Earlier reports have suggested that treatment with metronidazole cured nearly 90% of patients, with only a modest rate of recurrence of infection. In recent years, the rate of response to treatment with this drug has appeared to be much lower.
  
  
  METHODS
  We undertook a prospective, observational study of 207 patients who were treated with metronidazole for C. difficile colitis.
  
  
  RESULTS
  A total of 103 patients (50%) were cured by the initial course of therapy and had no recurrence of disease. Forty-six patients (22%) continued to have symptoms of colitis for > or = 10 days despite treatment, and 58 (28%) responded initially but had a recurrence within the ensuing 90 days. The mortality rate among patients who developed C. difficile colitis was 27%, and it was higher among patients who did not respond fully to an initial course of therapy, compared with those who did (33% vs. 21%; P < .05).
  
  
  CONCLUSIONS
  Because of the relatively poor response to therapy, additional approaches to prevention and/or treatment of C. difficile colitis appear to be warranted.
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. daniel.musher@med.va.gov
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Musher
authors.forename: Saima
authors.initials: S
authors.lastname: Aslam
authors.forename: Nancy
authors.initials: N
authors.lastname: Logan
authors.forename: Srikanth
authors.initials: S
authors.lastname: Nallacheru
authors.forename: Imran
authors.initials: I
authors.lastname: Bhaila
authors.forename: Franziska
authors.initials: F
authors.lastname: Borchert
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hamill
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use*; D011446:Prospective Studies; D017211:Treatment Failure; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin