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Increase in Use of Vancomycin for Clostridium difficile Infection in US Hospitals

Published online by Cambridge University Press:  02 January 2015

Amy L. Pakyz
Affiliation:
Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, Virginia
Norman V. Carroll
Affiliation:
Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, Virginia
Spencer E. Harpe
Affiliation:
Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, Virginia Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, Virginia
Michael Oinonen
Affiliation:
University HealthSystem Consortium, Oak Brook, Illinois
Ronald E. Polk
Affiliation:
Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, Virginia
Corresponding
E-mail address:

Abstract

Clostridium difficile infection (CDI) is a potentially serious disease for which the epidemiology has recently changed, because of an emerging drug-resistant strain of the pathogen. Metronidazole and oral vancomycin are the primary treatment agents.2 Metronidazole has been historically favored as the first-line agent, partly to reduce the selection pressure for vancomycin-resistant enterococci (VRE), although metronidazole can also select for VRE. Vancomycin was traditionally reserved for metronidazole treatment failure or life-threatening disease. In a study conducted before emergence of the epidemic strain, vancomycin was reported to be superior for the initial treatment of severe CDI and for treatment of CDI that does not respond to metronidazole. Expert opinion calling for the use of vancomycin as first-line therapy, especially for severe CDI emergence of the epidemic strain, and reports of decreased metronidazole efficacy may have impacted CDI treatment practices. The purpose of this study was to characterize trends in CDI treatment in US hospitals.

Type
Research Briefs
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

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