Editorial commentary: Vancomycin for your mother, metronidazole for your mother-in-law

摘要

Sherwood Gorbach coined this phrase, when reflecting on his clinical experience of the management of patients with severe manifestations of Clostridium difficile-associated disease (CDD). Many physicians consider that vancomycin is the clear choice for patients with severe CDD. However, only recently this has been subjected to randomised double blind, controlled trial. Zar and colleagues1 stratified 172 patients according to disease severity, to investigate whether one agent was superior for treating either mild or severe disease. They stratified patients using age, fever, hypoatbuminaemia, and leukocytosis as markers of severity. Patients were randomly assigned to receive oral metronidazole (250 mg 4 times per day) or oral vancomycin (125 mg 4 times per day) for 10 days. Among the patients with mild CDD, treatment with metronidazole or vancomycin resulted in clinical cure in 90% and 98% of the patients, respectively. Among the patients with severe CDD, treatment with metronidazole or vancomycin resulted in clinical cure in 76% and 97% of the patients, respectively. There were low relapse rates; clinical symptoms recurred in 15% of the patients treated with metronidazole and 14% of those treated with vancomycin.