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
N1 - Funding Information:
Hiroki Ohge received speaker honoraria from MSD K.K. , Atsushi Nakamura received speaker honoraria from MSD K.K., Yuka Yamagishi received speaker honoraria from MSD K.K., Taisho Toyama Pharmaceutical Co., Ltd. , and Sumitomo Dainippon Pharma Co., Ltd. , Katsunori Yanagihara received speaker honoraria from Pfizer Japan , Inc. , Daiichi Sankyo Co., Ltd. , Astellas Pharma, Inc. , Taisho Toyama Pharmaceutical Co., Ltd., Asahi Kasei Pharma Co., Ltd. , and BD Japan , research fees from Taisho Toyama Pharmaceutical Co., Ltd., Meiji Seika Pharma Co., Ltd. , Kyorin Pharmaceutical Co., Ltd. , and Roche Diagnostics K.K. , and research grants from Dainippon Sumitomo Pharma Co., Ltd. , MSD Japan , Daiichi Sankyo Co., Ltd., Astellas Pharma, Inc., Pfizer Japan, Inc., Taisho Toyama Pharmaceutical Co., Ltd., and Biofermin Seiyaku Co., Ltd. , Hiroshige Mikamo is advisory role of Toyama Chemical Co., Ltd., received speaker honoraria from Astellas Pharma Inc., Daiichi Sankyo Co., Ltd., MSD K.K., Shionogi & Co., Ltd. , Taisho Toyama Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Pfizer Japan Inc., and Meiji Seika Pharma Co., Ltd., payments for manuscript drafting from MSD K.K., and Taisho Toyama Pharmaceutical Co., Ltd., grant support from Taisho Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Co., Ltd., and Bayer Yakuhin Co., Ltd. , and donations from Astellas Pharma Inc., Daiichi Sankyo Co., Ltd., MSD K.K., Taisho Toyama Pharmaceutical Co., Ltd., Toyama Chemical Co., Ltd., and Pfizer Japan Inc., Hiroyuki Kunishima received speaker honoraria from MSD K.K., Taisho Toyama Pharmaceutical Co., Ltd.
Funding Information:
Hiroki Ohge received speaker honoraria from MSD K.K., Atsushi Nakamura received speaker honoraria from MSD K.K., Yuka Yamagishi received speaker honoraria from MSD K.K., Taisho Toyama Pharmaceutical Co., Ltd., and Sumitomo Dainippon Pharma Co., Ltd., Katsunori Yanagihara received speaker honoraria from Pfizer Japan, Inc., Daiichi Sankyo Co., Ltd., Astellas Pharma, Inc., Taisho Toyama Pharmaceutical Co., Ltd., Asahi Kasei Pharma Co., Ltd., and BD Japan, research fees from Taisho Toyama Pharmaceutical Co., Ltd., Meiji Seika Pharma Co., Ltd., Kyorin Pharmaceutical Co., Ltd., and Roche Diagnostics K.K., and research grants from Dainippon Sumitomo Pharma Co., Ltd., MSD Japan, Daiichi Sankyo Co., Ltd., Astellas Pharma, Inc., Pfizer Japan, Inc., Taisho Toyama Pharmaceutical Co., Ltd., and Biofermin Seiyaku Co., Ltd., Hiroshige Mikamo is advisory role of Toyama Chemical Co., Ltd., received speaker honoraria from Astellas Pharma Inc., Daiichi Sankyo Co., Ltd., MSD K.K., Shionogi & Co., Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Pfizer Japan Inc., and Meiji Seika Pharma Co., Ltd., payments for manuscript drafting from MSD K.K., and Taisho Toyama Pharmaceutical Co., Ltd., grant support from Taisho Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Co., Ltd., and Bayer Yakuhin Co., Ltd., and donations from Astellas Pharma Inc., Daiichi Sankyo Co., Ltd., MSD K.K., Taisho Toyama Pharmaceutical Co., Ltd., Toyama Chemical Co., Ltd., and Pfizer Japan Inc., Hiroyuki Kunishima received speaker honoraria from MSD K.K., Taisho Toyama Pharmaceutical Co., Ltd.
Publisher Copyright:
© 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
PY - 2018/11
Y1 - 2018/11
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
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U2 - 10.1016/j.jiac.2018.08.003
DO - 10.1016/j.jiac.2018.08.003
M3 - Article
C2 - 30170735
AN - SCOPUS:85052731147
VL - 24
SP - 907
EP - 914
JO - Journal of Infection and Chemotherapy
JF - Journal of Infection and Chemotherapy
SN - 1341-321X
IS - 11
ER -