Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole

Clin Infect Dis. 2005 Jun 1;40(11):1586-90. doi: 10.1086/430311. Epub 2005 Apr 25.


Background: 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.

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

Results: 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).

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

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Drug Administration Schedule
  • Enterocolitis, Pseudomembranous / drug therapy*
  • Follow-Up Studies
  • Humans
  • Metronidazole / therapeutic use*
  • Prospective Studies
  • Treatment Failure
  • Vancomycin / therapeutic use


  • Anti-Bacterial Agents
  • Metronidazole
  • Vancomycin