title: Oral teicoplanin for successful treatment of severe refractory Clostridium difficile infection.
abstract: BACKGROUND
  Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin.
  
  
  METHODS
  A one-year prospective study was carried out in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia. Patients with severe and complicated CDI who failed to respond to oral vancomycin and intravenous metronidazole combination therapy were enrolled. They were given oral teicoplanin 100 mg bi-daily. Patients were followed for recurrence for eight weeks.
  
  
  RESULTS
  Nine patients with a mean age of 70.8±9.4 years were analyzed. All patients had pseudomembranous colitis, and five had complicated disease. In four patients intracolonic delivery of vancomycin was also performed in addition to oral vancomycin and intravenous metronidazole prior to initiating teicoplanin, but without improvement. After teicoplanin initiation all patients achieved clinical cure. The mean time to resolution of diarrhoea after teicoplanin introduction was 6.3±4.5 days. There was no statistically significant difference in time to resolution of diarrhoea according to initial leucocyte count, age over 65 years, the presence of ileus, complicated disease and the use of concomitant antibiotic therapy (p = 0.652, 0,652, 0.374, 0.374, and 0,548, respectively). None of the patients experienced recurrence.
  
  
  CONCLUSIONS
  Oral teicoplanin might be a potential treatment for severe and complicated refractory CDI, but further studies are required.
authors.affiliation: Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia. nanika1984@yahoo.com.
authors.forename: Natasa
authors.initials: N
authors.lastname: Popovic
authors.forename: Milos
authors.initials: M
authors.lastname: Korac
authors.forename: Zorica
authors.initials: Z
authors.lastname: Nesic
authors.forename: Branko
authors.initials: B
authors.lastname: Milosevic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Urosevic
authors.forename: Djordje
authors.initials: D
authors.lastname: Jevtovic
authors.forename: Mijomir
authors.initials: M
authors.lastname: Pelemis
authors.forename: Dragan
authors.initials: D
authors.lastname: Delic
authors.forename: Milica
authors.initials: M
authors.lastname: Prostran
authors.forename: Ivana
authors.initials: I
authors.lastname: Milosevic
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000188:drug therapy* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D003967:Diarrhea / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D055771:Serbia; D017334:Teicoplanin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin