Vol.70 No.2 March 2022

Evaluation of metronidazole treatment for Clostridioides difficile infection

Tomohiro Izumisawa¹⁾, Tomoyoshi Kaneko¹⁾, Yuko Nagano²⁾, Moeko Sato²⁾, Yoshiko Miyamoto³⁾, Miyuki Sugano³⁾, Hiroyuki Kageyama¹⁾, Hideo Hasegawa¹⁾, Tomoko Hasegawa²⁾, Tetsuya Horino⁴⁾, Hiroshi Yoshida⁵⁾ and Hiroki Tsukada⁴⁾

¹⁾Department of Pharmacy, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, Japan
²⁾Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
³⁾Department of Infection Control Room, The Jikei University Kashiwa Hospital
⁴⁾Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine
⁵⁾Department of Laboratory Medicine, The Jikei University School of Medicine

Abstract

In the Japanese guideline for the treatment of Clostridioides difficile infection (CDI), metronidazole (MNZ) is recommended as the drug of first choice for non-severe cases. To clarify the efficacy of MNZ for CDI, we conducted a retrospective study at The Jikei University Kashiwa Hospital between April 2018 and March 2021. Of the 115 cases enrolled in this study, 52 of 57 cases (91.2%) treated with MNZ and 54 of 58 cases (93.1%) treated with VCM improved, with no significant difference in the treatment efficacy rate between the two groups (P=0.47). While the efficacy rate was 88.9% in the MNZ group and 97.2% in the VCM group in non-severe cases, it was 100% in the MNZ group and 86.4% in the VCM group in the severe cases. Thus, there was no significant difference in the efficacy rate between the patients treated with MNZ and those treated with VCM in either the non-severe or the severe cases (P=0.52 and 0.62). In addition, 12.2% of all the patients had relapse within 8 weeks of treatment completion, and the relapse rate was not significantly different between the patients treated with MNZ and those treated with VCM (7.7% vs. 16.7%, P=0.24). Moreover, there was no significant difference in the relapse rate between the patients treated with MNZ and those treated with VCM in either the non-severe (10.0% vs. 17.1%, P=0.50) or the severe cases (0% vs. 15.8%, P=0.28). The results suggest that MNZ was effective for both non-severe and severe cases of CDI. Therefore, further research is needed on appropriate severity classifications and therapeutic drugs for CDI in Japan.

Key word

Clostridioides difficile, metronidazole, vancomycin, efficacy, relapse

Received

October 29, 2021

Accepted

December 16, 2021

Jpn. J. Chemother. 70 (2): 210-216, 2022