Abstract
Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin. A one-year prospective study was carried out in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia. Patients with severe and complicated CDI who failed to respond to oral vancomycin and intravenous metronidazole combination therapy were enrolled. They were given oral teicoplanin 100 mg bi-daily. Patients were followed for recurrence for eight weeks. Nine patients with a mean age of 70.8±9.4 years were analyzed. All patients had pseudomembranous colitis, and five had complicated disease. In four patients intracolonic delivery of vancomycin was also performed in addition to oral vancomycin and intravenous metronidazole prior to initiating teicoplanin, but without improvement. After teicoplanin initiation all patients achieved clinical cure. The mean time to resolution of diarrhoea after teicoplanin introduction was 6.3±4.5 days. There was no statistically significant difference in time to resolution of diarrhoea according to initial leucocyte count, age over 65 years, the presence of ileus, complicated disease and the use of concomitant antibiotic therapy (p = 0.652, 0,652, 0.374, 0.374, and 0,548, respectively). None of the patients experienced recurrence. Oral teicoplanin might be a potential treatment for severe and complicated refractory CDI, but further studies are required.
Highlights
Clostridium difficile is the leading cause of hospital-acquired diarrhoea
The aim of the study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory Clostridium difficile infection (CDI) treated with oral teicoplanin
Patients with severe or severe complicated CDI who failed to respond to a 14-day treatment regimen with oral vancomycin and intravenous metronidazole were enrolled into the teicoplanin study
Summary
There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin. Intravenous tygecyclin, intravenous immunoglobulins, oral vancomycin in higher doses, and vancomycin enema are some of the suggested treatment regimens but they were all applied to a small number of patients [3,4,5,6] Oral teicoplanin is another antibiotic, which was proven to be successful in the treatment of patients with CDI, including those with severe disease [7,8]. Previous studies have not analysed the role of teicoplanin in the treatment of refractory disease
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