Oral teicoplanin versus oral vancomycin for the treatment of severe Clostridium difficile infection: a prospective observational study
- 432 Downloads
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.
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.
- 8.Debast SB, Bauer MP, Kuijper EJ, European Society of Clinical Microbiology and Infectious Diseases Collaborators (13) (2014) European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 20(Suppl 2):1–26CrossRefPubMedGoogle Scholar
- 10.EMA Europa (2017) Targocid- summary of product characteristics, labelling and package leaflet. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Targocid_30/WC500143825.pdf. Accessed 26 December 2017
- 12.No authors listed (1997) Declaration of Helsinki recommendation guiding physicians in biomedical research involving human subjects. JAMA 277:925–926Google Scholar
- 13.Lucado J, Gould C, Elixhauser A (2009) Clostridium difficile infections (CDI) in hospital stays. Healthcare cost and utilization project, Agency for Healthcare Research and Quality. Statistical brief #124. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb124.pdf. Accessed 26 December 2017
- 32.Lee C, Louie TJ, Weiss K, Valiquette L, Gerson M, Arnott W, Gorbach SL (2016) Fidaxomicin versus Vancomycin in the treatment of Clostridium difficile infection: Canadian outcomes. Can J Infect Dis Med Microbiol 118:725–732Google Scholar