Vancomycin or metronidazole for treatment of clostridium difficile infection: clinical and economic analyses

Perras C, Tsakonas E, Ndegwa S, Conly J, Valiquette L, Farrah K
Record ID 32011000141
Authors' objectives:

The research objectives were to evaluate the relative clinical effectiveness, the relative cost-effectiveness, and the budget impact of using vancomycin or metronidazole in the management of initial episodes of moderate to severe C. difficile infection in children or in adults. Clinical practice guidelines recommendations were also reviewed.

Authors' recommendations: Five randomized controlled trials included hospitalized adult patients with initial or recurrent episodes of C. difficile infection. Based on the limited data that were obtained from subgroup analyses, the use of metronidazole and of vancomycin leads to a similar clinical cure rate among hospitalized adult patients with initial or recurrent C. difficile infection of moderate severity. A higher clinical cure rate is reported after the use of vancomycin by hospitalized adult patients with initial or recurrent severe C. difficile infection. Conclusions about the outcomes of recurrences, complications, and serious adverse events cannot be made.The use of oral vancomycin by patients with severe disease will incur an incremental cost of $1,161 per clinical cure, but the use of vancomycin may reduce net health expenditure, if it has an impact on hospitalization costs through reduced length of stay due to earlier discharge or reductions in serious complications.The annual incremental costs of using vancomycin as first-line treatment in hospitalized patients with severe C. difficile infection are, at the national level, $734,826 for hospitals and $398,454 for community drug budgets.
Project Status: Completed
Year Published: 2011
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Clostridioides difficile
  • Metronidazole
  • Vancomycin
Organisation Name: Canadian Agency for Drugs and Technologies in Health
Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
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Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)
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