Efficacy Assessment of the Co-Administration of Vancomycin and Metronidazole in Clostridioides difficile-Infected Mice Based on Changes in Intestinal Ecology

J Microbiol Biotechnol. 2024 Apr 28;34(4):828-837. doi: 10.4014/jmb.2312.12034. Epub 2024 Feb 29.


Vancomycin (VAN) and metronidazole (MTR) remain the current drugs of choice for the treatment of non-severe Clostridioides difficile infection (CDI); however, while their co-administration has appeared in clinical treatment, the efficacy varies greatly and the mechanism is unknown. In this study, a CDI mouse model was constructed to evaluate the therapeutic effects of VAN and MTR alone or in combination. For a perspective on the intestinal ecology, 16S rRNA amplicon sequencing and non-targeted metabolomics techniques were used to investigate changes in the fecal microbiota and metabolome of mice under the co-administration treatment. As a result, the survival rate of mice under co-administration was not dramatically different compared to that of single antibiotics, and the former caused intestinal tissue hyperplasia and edema. Co-administration also significantly enhanced the activity of amino acid metabolic pathways represented by phenylalanine, arginine, proline, and histidine, decreased the level of deoxycholic acid (DCA), and downregulated the abundance of beneficial microbes, such as Bifidobacterium and Akkermansia. VAN plays a dominant role in microbiota regulation in co-administration. In addition, co-administration reduced or increased the relative abundance of antibiotic-sensitive bacteria, including beneficial and harmful microbes, without a difference. Taken together, there are some risks associated with the co-administration of VAN and MTR, and this combination mode should be used with caution in CDI treatment.

Keywords: Clostridioides difficile infection; Vancomycin; co-administration; fecal microbiota; metabolome; metronidazole.

MeSH terms

  • Animals
  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / pharmacology
  • Bacteria / classification
  • Bacteria / drug effects
  • Bacteria / genetics
  • Clostridioides difficile* / drug effects
  • Clostridioides difficile* / genetics
  • Clostridium Infections* / drug therapy
  • Clostridium Infections* / microbiology
  • Disease Models, Animal*
  • Drug Therapy, Combination*
  • Feces* / microbiology
  • Gastrointestinal Microbiome* / drug effects
  • Intestines / drug effects
  • Intestines / microbiology
  • Male
  • Metabolome / drug effects
  • Metronidazole* / administration & dosage
  • Mice
  • RNA, Ribosomal, 16S* / genetics
  • Vancomycin* / administration & dosage
  • Vancomycin* / pharmacology


  • Metronidazole
  • Vancomycin
  • Anti-Bacterial Agents
  • RNA, Ribosomal, 16S