6/30/23, 12:39 AM Vancomycin vs. metronidazole for C. difficile colitis Pathway Feedback Search Clinical Topics Home Studies Vancomycin vs. metronidazole for C. difficile colitis Vancomycin vs. metronidazole for C. difficile colitis Disease Clostridioides difficile infection Trial question What is the effect of vancomycin in patients with C. difficile-associated diarrhea? Study design Single center Double blinded RCT Population Characteristics of study participants 45.5% female N = 172 54.5% male 172 patients (68 female, 82 male) Inclusion criteria: patients with C. difficile-associated diarrhea were stratified according to whether they had mild or severe disease based on clinical criteria Key exclusion criteria: perforated viscus or bowel obstruction; prior failure of C. difficile- associated diarrhea to respond to either study drug; pregnancy; history of allergy to either study drug; or treatment with oral vancomycin or parenteral or oral metronidazole during the previous 14 days Interventions N=71 vancomycin (125 mg QID PO for 10 days) N=79 metronidazole (250 mg QID PO for 10 days) Primary outcome Cure 97.0 % 97 https://web.pathway.md/studies/recEMrhrCChPON0S2 1/2 6/30/23, 12:39 AM Vancomycin vs. metronidazole for C. difficile colitis Pathway 84 72.8 % 48.5 % Significant increase 24.3 % NNH = 8 0.0 % Vancomycin Metronidazole Significant increase in cure (97% vs. 84%; RR 1.15, 95% CI 0.33 to 1.97) Secondary outcomes No significant difference in cure, in patients with mild disease (98% vs. 90%; RR 1.09, 95% CI -1.22 to 3.4) Significant increase in cure rate, in patients with severe disease (97% vs. 76%; RR 1.28, 95% CI 0.2 to 2.36) Conclusion In patients with C. difficile-associated diarrhea were stratified according to whether they had mild or severe disease based on clinical criteria, vancomycin was superior to metronidazole with respect to cure. Reference Zar FA, Bakkanagari SR, Moorthi KM et al. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007 Aug 1;45(3):302-7. Open reference URL https://web.pathway.md/studies/recEMrhrCChPON0S2 2/2