What is it about?
Clostridium (now Clostridioides) difficile infection causes diarrhoea and colitis, sometimes severe, mostly after antibiotic use. A review published in the International Journal of Antimicrobial Agents provided practical guidance on its diagnosis and treatment. In this letter we commented on the review and pointed out an error: it recommended adding intravenous vancomycin to oral vancomycin for severe infection. However, vancomycin given intravenously does not reach the colon in meaningful amounts and is not effective for this infection. The authors of the review agreed and clarified that severe infection should be treated with oral vancomycin, adding intravenous metronidazole when oral drugs cannot reach the gut.
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Why is it important?
Treatment errors in widely read reviews can easily spread into clinical practice. This exchange corrected a potentially harmful recommendation and reinforced a key pharmacological principle: for C. difficile infection, the antibiotic must reach the colon, which is why vancomycin must be given orally.
Perspectives
Clostridioides difficile has been a long-standing focus of my research, and I believe that letters to the editor are an important part of scientific dialogue. A small correction can prevent ineffective treatments for many patients.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Re: The challenge of Clostridium difficile infection: Overview of clinical manifestations, diagnostic tools and therapeutic options, International Journal of Antimicrobial Agents, March 2016, Elsevier,
DOI: 10.1016/j.ijantimicag.2015.12.012.
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