PMID- 26444424
OWN - NLM
STAT- MEDLINE
DCOM- 20160609
LR  - 20201209
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 10
IP  - 10
DP  - 2015
TI  - Efficacy and Safety of Metronidazole Monotherapy versus Vancomycin Monotherapy or 
      Combination Therapy in Patients with Clostridium difficile Infection: A 
      Systematic Review and Meta-Analysis.
PG  - e0137252
LID - 10.1371/journal.pone.0137252 [doi]
LID - e0137252
AB  - BACKGROUND: Clostridium difficile infection (CDI) has become a global 
      epidemiological problem for both hospitalized patients and outpatients. The most 
      commonly used drugs to treat CDI are metronidazole and vancomycin. The aim of 
      this study was to compare the efficacy and safety of metronidazole monotherapy 
      with vancomycin monotherapy and combination therapy in CDI patients. METHODS: A 
      comprehensive search without publication status or other restrictions was 
      conducted. Studies comparing metronidazole monotherapy with vancomycin 
      monotherapy or combination therapy in patients with CDI were considered eligible. 
      Meta-analysis was performed using the Mantel-Haenszel fixed-effects model, and 
      odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated and 
      reported. RESULTS: Of the 1910 records identified, seventeen studies from 
      thirteen articles (n = 2501 patients) were included. No statistically significant 
      difference in the rate of clinical cure was found between metronidazole and 
      vancomycin for mild CDI (OR = 0.67, 95% CI (0.45, 1.00), p = 0.05) or between 
      either monotherapy and combination therapy for CDI (OR = 1.07, 95% CI (0.58, 
      1.96), p = 0.83); however, the rate of clinical cure was lower for metronidazole 
      than for vancomycin for severe CDI (OR = 0.46, 95% CI (0.26, 0.80), p = 0.006). 
      No statistically significant difference in the rate of CDI recurrence was found 
      between metronidazole and vancomycin for mild CDI (OR = 0.99, 95% CI (0.40, 
      2.45), p = 0.98) or severe CDI (OR = 0.98, 95% CI (0.63, 1.53), p = 0.94) or 
      between either monotherapy and combination therapy for CDI (OR = 0.91, 95% CI 
      (0.66, 1.26), p = 0.56). In addition, there was no significant difference in the 
      rate of adverse events (AEs) between metronidazole and vancomycin (OR = 1.18, 95% 
      CI (0.80, 1.74), p = 0.41). In contrast, the rate of AEs was significantly lower 
      for either monotherapy than for combination therapy (OR = 0.30, 95% CI (0.17, 
      0.51), p < 0.0001). CONCLUSIONS: Metronidazole and vancomycin are equally 
      effective for the treatment of mild CDI, but vancomycin is superior for the 
      treatment of severe CDI. Combination therapy is not superior to monotherapy 
      because it appears to be associated with an increase in the rate of AEs.
FAU - Li, Rui
AU  - Li R
AD  - College of Pharmacy, Chongqing Medical University, Chongqing, China.
FAU - Lu, Laichun
AU  - Lu L
AD  - Department of Pharmacy, Third Affiliated Hospital, Third Military Medical 
      University, Chongqing, China.
FAU - Lin, Yu
AU  - Lin Y
AD  - College of Pharmacy, Chongqing Medical University, Chongqing, China.
FAU - Wang, Mingxia
AU  - Wang M
AD  - College of Pharmacy, Chongqing Medical University, Chongqing, China.
FAU - Liu, Xin
AU  - Liu X
AD  - College of Pharmacy, Chongqing Medical University, Chongqing, China.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20151007
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Anti-Bacterial Agents)
RN  - 140QMO216E (Metronidazole)
RN  - 6Q205EH1VU (Vancomycin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anti-Bacterial Agents/adverse effects/*therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - Clostridioides difficile/*drug effects
MH  - Drug Therapy, Combination
MH  - Enterocolitis, Pseudomembranous/*drug therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Metronidazole/adverse effects/*therapeutic use
MH  - Middle Aged
MH  - Treatment Outcome
MH  - Vancomycin/adverse effects/*therapeutic use
PMC - PMC4621873
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2015/10/09 06:00
MHDA- 2016/06/10 06:00
PMCR- 2015/10/07
CRDT- 2015/10/08 06:00
PHST- 2015/04/01 00:00 [received]
PHST- 2015/08/13 00:00 [accepted]
PHST- 2015/10/08 06:00 [entrez]
PHST- 2015/10/09 06:00 [pubmed]
PHST- 2016/06/10 06:00 [medline]
PHST- 2015/10/07 00:00 [pmc-release]
AID - PONE-D-15-12504 [pii]
AID - 10.1371/journal.pone.0137252 [doi]
PST - epublish
SO  - PLoS One. 2015 Oct 7;10(10):e0137252. doi: 10.1371/journal.pone.0137252. 
      eCollection 2015.