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Clin Infect Dis. 2005 Jun 1;40(11):1586-90. Epub 2005 Apr 25.

Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole.

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  • 1Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.



Clostridium difficile is a frequent cause of serious nosocomial infection. Earlier reports have suggested that treatment with metronidazole cured nearly 90% of patients, with only a modest rate of recurrence of infection. In recent years, the rate of response to treatment with this drug has appeared to be much lower.


We undertook a prospective, observational study of 207 patients who were treated with metronidazole for C. difficile colitis.


A total of 103 patients (50%) were cured by the initial course of therapy and had no recurrence of disease. Forty-six patients (22%) continued to have symptoms of colitis for > or = 10 days despite treatment, and 58 (28%) responded initially but had a recurrence within the ensuing 90 days. The mortality rate among patients who developed C. difficile colitis was 27%, and it was higher among patients who did not respond fully to an initial course of therapy, compared with those who did (33% vs. 21%; P < .05).


Because of the relatively poor response to therapy, additional approaches to prevention and/or treatment of C. difficile colitis appear to be warranted.

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