Oral vancomycin versus metronidazole for the treatment of Clostridioides difficile infection: Meta-analysis of randomized controlled trials

TY - JOUR

T1 - Oral vancomycin versus metronidazole for the treatment of Clostridioides difficile infection

T2 - Meta-analysis of randomized controlled trials

AU - Igarashi, Yuki

AU - Tashiro, Sho

AU - Enoki, Yuki

AU - Taguchi, Kazuaki

AU - Matsumoto, Kazuaki

AU - Ohge, Hiroki

AU - Suzuki, Hiromichi

AU - Nakamura, Atsushi

AU - Mori, Nobuaki

AU - Morinaga, Yoshitomo

AU - Yamagishi, Yuka

AU - Yoshizawa, Sadako

AU - Yanagihara, Katsunori

AU - Mikamo, Hiroshige

AU - Kunishima, Hiroyuki

PY - 2018/1/1

Y1 - 2018/1/1

N2 - At present, vancomycin (VCM) and metronidazole (MNZ) are used for the first-line standard treatment of Clostridioides difficile infection (CDI). However, their differential use has not been sufficiently investigated. In this study, a meta-analysis on differences in the efficacy for CDI between VCM and MNZ was performed. Reports of randomized controlled studies using VCM or MNZ to treat CDI were surveyed. Meta-analysis was performed using the Mantel-Haenszel method and random-effects model, and the risk ratio and 95% confidence interval were calculated. Excluding overlapping reports, 1043 reports were extracted and 5 randomized controlled studies were extracted. There was no difference in therapeutic effects for CDI between VCM and MNZ (RR = 1.08, 95% CI (0.99–1.17), p = 0.09, I2 = 37%). On subgroup analysis by the severity, there was no difference in the clinical effects for CDI between VCM and MNZ in non-severe cases (risk ratio: 1.09, 95% confidence interval: 1.00–1.19, p = 0.06), but the clinical effects of VCM were significantly higher than those of MNZ in severe cases (risk ratio: 1.19, 95% confidence interval: 1.02–1.39, p = 0.03). No significant difference was noted in the recurrence rate, incidence of adverse event, time to exhibit therapeutic effects, or judgment of the bacteriological effects. As the therapeutic effects of VCM were superior in severe CDI cases, VCM should be considered first in severe cases.

AB - At present, vancomycin (VCM) and metronidazole (MNZ) are used for the first-line standard treatment of Clostridioides difficile infection (CDI). However, their differential use has not been sufficiently investigated. In this study, a meta-analysis on differences in the efficacy for CDI between VCM and MNZ was performed. Reports of randomized controlled studies using VCM or MNZ to treat CDI were surveyed. Meta-analysis was performed using the Mantel-Haenszel method and random-effects model, and the risk ratio and 95% confidence interval were calculated. Excluding overlapping reports, 1043 reports were extracted and 5 randomized controlled studies were extracted. There was no difference in therapeutic effects for CDI between VCM and MNZ (RR = 1.08, 95% CI (0.99–1.17), p = 0.09, I2 = 37%). On subgroup analysis by the severity, there was no difference in the clinical effects for CDI between VCM and MNZ in non-severe cases (risk ratio: 1.09, 95% confidence interval: 1.00–1.19, p = 0.06), but the clinical effects of VCM were significantly higher than those of MNZ in severe cases (risk ratio: 1.19, 95% confidence interval: 1.02–1.39, p = 0.03). No significant difference was noted in the recurrence rate, incidence of adverse event, time to exhibit therapeutic effects, or judgment of the bacteriological effects. As the therapeutic effects of VCM were superior in severe CDI cases, VCM should be considered first in severe cases.

KW - Clostridioides difficile

KW - Clostridioides difficile infection (CDI)

KW - Metronidazole

KW - Vancomycin

UR - http://www.scopus.com/inward/record.url?scp=85052731147&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052731147&partnerID=8YFLogxK

U2 - 10.1016/j.jiac.2018.08.003

DO - 10.1016/j.jiac.2018.08.003

M3 - Article

C2 - 30170735

AN - SCOPUS:85052731147

JO - Journal of Infection and Chemotherapy

JF - Journal of Infection and Chemotherapy

SN - 1341-321X

ER -