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

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
Yuki IgarashiHiroyuki Kunishima

Abstract

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, tim...Continue Reading

Citations

Aug 3, 2020·Current Opinion in Critical Care·Benoit GuerySarah Tschudin-Sutter
Mar 14, 2020·Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy·Hiroyuki OkumuraMarci English
Nov 7, 2020·Critical Care Medicine·Max W AdelmanColleen S Kraft
Mar 31, 2021·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·Evelyne Santana GirãoSilvia Figueiredo Costa
May 24, 2021·Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy·Kana MisawaKazuaki Matsumoto

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