Abstract
The infection with Clostridium difficile (CDI), which appeared at epidemic level, after acquiring the germ of some fluoroquinolone resistance genes, initially considered nosocomial infection and adverse effect post-antibiotic therapy, is affecting more and more people without risk factors and extending into the community. This paper proposes an analysis of the two main antibiotics used in therapy: metronidazole and vancomycin, the evidence of efficacy in the literature and the chemical stability of antibiotics in simulated gastrointestinal fluid. Based on UV-Vis absorption spectra, it can be considered that there are no major changes in the chemical structure of the investigated drugs in the presence of gastro-duodenal conditions. Clinical impact of comparative treatment with metronidazole and vancomycin has also been studied, in a group of 720 CDI patients hospitalized during the period 1.01.2017-31.12.2018 in the Clinical Hospital St. Parascheva of Infectious Diseases Galati. From this group, two subgroups were selected, one of 284 patients receiving oral vancomycin treatment and one group of 62 patients receiving oral metronidazole for an initial nonsevere episode of CDI. The number of days from the beginning of the treatment until the normalization of the stool, the length of hospitalization, the number of days of antibiotic treatment and the percentage of relapses were comparable in the two groups, the percentage of deaths in the first 30 days from the episode of CDI was higher in the vancomycin-treated group, probably due mainly to the severe comorbidities of these patients. The conclusion of the study is that the treatments with metronidazole and vancomycin, of the initial episode, nonsevere of CDI are comparable as a therapeutic response, provided that the patients treated with metronidazole do not associate hepatic, renal or neurological impairment due to the risk of adverse reactions.
Highlights
Clostridium difficile infection (CDI) is a therapeutic challenge at this time, from the point of view of the few antibiotics active on this germ, the possibility of evolution of infection to toxic megacolon forms, high rates of relapse and mortality, and multiple comorbidities of these patients requiring complex concomitant therapy
The first CDI therapy guides, including the current Romanian guide, recommend for this first nonsevere episode of CDI, oral methronidazole 10-14 days, of first intention, the latest CDI therapy guide written by American Society of Infectious Diseases and Epidemiology in 2017 recommends for the first intention, oral vancomycin or oral fidaxomicin and only if the access to vancomycin or fidaxomicin is limited, to use metronidazole
The UV-Vis spectra of vancomycin and metro-nidazole were recorded from their aqueous solutions in 170-800 nm range
Summary
Clostridium difficile infection (CDI) is a therapeutic challenge at this time, from the point of view of the few antibiotics active on this germ, the possibility of evolution of infection to toxic megacolon forms, high rates of relapse and mortality, and multiple comorbidities of these patients requiring complex concomitant therapy. Subsequent clinical studies have observed metronidazoleinduced neurotoxicity and encephalopathy in patients with cirrhosis [3, 4] and the American CDI treatment guide draw attention to prudence in administration of metronidazole over 10 days due to the risk of cumulative and potentially irreversible neurotoxicity [5].
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