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Lack of Benefit With Combination Therapy for Clostridium difficile Infection

  • Jessica C. Njoku (a1) (a2), Trevor C. Van Schooneveld (a1) (a3), Mark E. Rupp (a1) (a3), Keith M. Olsen (a1) (a2), Fang Qiu (a4), Jane L. Meza (a4) and Elizabeth D. Hermsen (a2) (a5)...

Limited data exist regarding combination therapy for Clostridium difficile infection (CDI). After adjusting for confounders in a cohort of patients with CDI and≥1 year old, combination therapy was not associated with significant differences in clinical outcomes, but it was associated with prolonged duration of therapy (1.22 days; 95% confidence interval, 1.03–1.44 days; P=.02).

Infect Control Hosp Epidemiol 2017;38:602–605

Corresponding author
Address correspondence to Jessica C. Njoku, PharmD, Good Shepherd Medical Center, 700 E Marshall Ave, Longview, TX 75601 (
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1. Cohen, SH, Gerding, DN, Johnson, S, et al; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431455.
2. Hensgens, MP, Goorhuis, A, Dekkers, OM, et al. All-cause and disease-specific mortality in hospitalized patients with Clostridium difficile infection: a multicenter cohort study. Clin Infect Dis 2013;56:11081116.
3. Musher, DM, Aslam, S, Logan, N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005;40:15861590.
4. Pelaez, T, Alcala, L, Alonso, R, et al. Reassessment of Clostridium difficile susceptibility to metronidazole and vancomycin. Antimicrob Agents Chemother 2002;46:16471650.
5. Diff Quik Chek Complete. TechLab website. Published 2105. Accessed December 5, 2016.
6. Mullane, KM, Miller, MA, Weiss, K, et al. SL. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections. Clin Infect Dis 2011;53:440447.
7. Zar, FA, Bakkanagari, SR, Moorthi, KM, et al. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile–associated diarrhea, stratified by disease severity. Clin Infect Dis 2007;45:302307.
8. Li, R, Lu, L, Lin, Y, Wang, M, Liu, X. Efficacy and safety of metronidazole monotherapy versus vancomycin monotherapy or combination therapy in patients with Clostridium difficile infection: a systematic review and meta-analysis. PLoS One 2015;10:e0137252.
9. Bass, SN, Bauer, SR, Neuner, EA, Lam, SW. Comparison of treatment outcomes with vancomycin alone versus combination therapy in severe Clostridium difficile infection. J Hosp Infect 2013;85:2227.
10. Rokas, KEE, Johnson, JW, Beardsley, JR, et al. The addition of intravenous metronidazole to oral vancomycin is associated with improved mortality in critically ill patients with Clostridium difficile infection. Clin Infect Dis 2015;61:934941.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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