COMPARISON OF VANCOMYCIN, TEICOPLANIN, METRONIDAZOLE, AND FUSIDIC ACID FOR THE TREATMENT OF CLOSTRIDIUM-DIFFICILE-ASSOCIATED DIARRHEA

We conducted a prospective, randomized study to compare the efficacy o f oral fusidic acid, oral metronidazole, oral vancomycin, and oral tei coplanin for the treatment of Clostridium difficile-associated diarrhe a. Treatment resulted in clinical cure for 94% of the patients who wer e treated with vancomycin, 96% of those treated with teicoplanin, 93% of those treated with fusidic acid, and 94% of those treated with metr onidazole. Clinical symptoms recurred in 16% of patients treated with vancomycin, 7% of those treated with teicoplanin, 28% of those treated with fusidic acid, and 16% of those treated with metronidazole. There was asymptomatic carriage of C. difficile toxin in 13% of patients tr eated with vancomycin, 4% of those treated with teicoplanin, 24% of th ose treated with fusidic acid, and 16% of those treated with metronida zole. No adverse effects related to therapy with vancomycin or teicopl anin were observed. Considering the costs of treatment, our findings s uggest that metronidazole is the drug of choice for C. difficile-assoc iated diarrhea and that glycopeptides should be reserved for patients who cannot tolerate metronidazole or who do not respond to treatment w ith this drug.