Oral teicoplanin versus oral vancomycin for the treatment of severe Clostridium difficile infection: a prospective observational study

  • Natasa Popovic
  • Milos Korac
  • Zorica Nesic
  • Branko Milosevic
  • Aleksandar Urosevic
  • Djordje Jevtovic
  • Nikola Mitrovic
  • Aleksandar Markovic
  • Jelena Jordovic
  • Natasa Katanic
  • Aleksandra Barac
  • Ivana Milosevic
Original Article

Abstract

The aim of this study was to compare clinical cure rate, recurrence rate and time to resolution of diarrhea in patients with severe and severe-complicated Clostridium difficile infection (CDI) treated with teicoplanin or vancomycin. This two-year prospective observational study included patients with first episode or first recurrence of CDI who had severe or severe-complicated CDI and were treated with teicoplanin or vancomycin. Primary outcomes of interest were clinical cure rate at discharge and recurrence rate after eight weeks follow up, and secondary outcomes were all-cause mortality and time to resolution of diarrhea. Among 287 study patients, 107 were treated with teicoplanin and 180 with vancomycin. The mean age of patients was 73.5 ± 10.6 years. One hundred eighty six patients (64.8%) had prior CDI episode. Severe complicated disease was detected in 23/107 (21.5%) and 42/180 (23.3%) patients treated with teicoplanin and vancomycin, respectively. There was no statistically significant difference in time to resolution of diarrhea between two treatment arms (6.0 ± 3.4 vs 6.2 ± 3.1 days, p = 0.672). Treatment with teicoplanin resulted in significantly higher clinical cure rate compared to vancomycin [90.7% vs 79.4%, p = 0.013, odds ratio (OR) (95% confidence interval (CI)) 2.51 (1.19–5.28)]. Recurrence rates were significantly lower in patients treated with teicoplanin [9/97 (9.3%) vs 49/143 (34.3%), p < 0.001, OR (95%CI) 0.20 (0.09–0.42)]. There was no statistically significant difference in overall mortality rate. Teicoplanin might be a good treatment option for patients with severe CDI. Patients treated with teicoplanin experienced remarkably lower recurrence rates compared to vancomycin-treated patients.

Notes

Compliance with ethical standards

All authors declare that they have no conflict of interest. The authors received no financial support for this research.

All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants (or their caregivers) included in the study.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Natasa Popovic
    • 1
    • 2
  • Milos Korac
    • 1
    • 2
  • Zorica Nesic
    • 2
    • 3
  • Branko Milosevic
    • 1
    • 2
  • Aleksandar Urosevic
    • 1
    • 2
  • Djordje Jevtovic
    • 1
    • 2
  • Nikola Mitrovic
    • 1
    • 2
  • Aleksandar Markovic
    • 1
  • Jelena Jordovic
    • 1
  • Natasa Katanic
    • 1
    • 4
  • Aleksandra Barac
    • 1
  • Ivana Milosevic
    • 1
    • 2
  1. 1.Clinical Centre of SerbiaUniversity Hospital for Infectious and Tropical DiseasesBelgradeSerbia
  2. 2.School of MedicineUniversity of BelgradeBelgradeSerbia
  3. 3.Department of PharmacologyClinical Pharmacology and ToxicologyBelgradeSerbia
  4. 4.School of MedicineUniversity of Pristina-Kosovska MitrovicaKosovska MitrovicaSerbia

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