SynthesisThe Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases
A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity.
Synthesis in The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 45 citations in OpenAlex.
- Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions: A Meta-Analysis.JAMA network open · 2024Pooled it
- Cadazolid vs Vancomycin for the Treatment of Clostridioides difficile Infection: Systematic Review with Meta-analysis.Current clinical pharmacology · 2020Pooled it
- Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults.The Cochrane database of systematic reviews · 2017Pooled it
- Epidemiology ofAntibiotics (Basel, Switzerland) · 2026Article
- Combination of mitomycin C and low-dose metronidazole synergistically againstAntimicrobial agents and chemotherapy · 2025Article
- Healthcare-AssociatedMicroorganisms · 2025Article
- Evaluating Vancomycin Monotherapy and Dual Therapy with Nifuroxazide for Medium-Severe Clostridioides Difficile Infection.Antibiotics (Basel, Switzerland) · 2025Article
- Management of severe and fulminantJournal of medical microbiology · 2025Review
- Management of Severe Colitis and Toxic Megacolon.Clinics in colon and rectal surgery · 2024Review
- Epidemiology and Outcomes of RecurrentOpen forum infectious diseases · 2024Article
- Symptoms, Treatment, and Outcomes of COVID-19 Patients Coinfected withAntibiotics (Basel, Switzerland) · 2023Article
- Redistribution of the Novel Clostridioides difficile Spore Adherence Receptor E-Cadherin by TcdA and TcdB Increases Spore Binding to Adherens Junctions.Infection and immunity · 2023Article
- Which is the Preferred Regimen for Non-SevereInfection & chemotherapy · 2022Review
- Article
- Using a ligate intestinal loop mouse model to investigate Clostridioides difficile adherence to the intestinal mucosa in aged mice.PloS one · 2021Article
- Impact of Delayed Oral Vancomycin for SevereHospital pharmacy · 2019Article
- Burden ofIranian journal of public health · 2019Review
- Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO).Annals of hematology · 2018Review
- Does Adjunctive Tigecycline Improve Outcomes in Severe-Complicated, NonoperativeOpen forum infectious diseases · 2017Article
- Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2017Observational
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The aim of this meta-analysis was to compare the efficacy of metronidazole and vancomycin for the treatment of Clostridium difficile infection, especially to investigate which agent was superior for treating either mild or severe C. difficile infection. A meta-analysis of randomized controlled trials and cohort studies identified in Pubmed, Embase, and the Cochrane Library was conducted. Four randomized controlled trials and two cohort studies involving 1218 patients were included in this meta-analysis. Metronidazole was inferior to vancomycin for treating C. difficile infection in terms of both initial clinical cure rates (risk ratio, RR=0.91, 95% confidence interval, CI=0.84-0.98, p=0.02) and sustained cure rates (RR=0.88, 95% CI=0.82-0.96, p=0.003). For mild C. difficile infection, the efficacy of metronidazole and vancomycin resulted in similar clinical cure rates (RR=0.94, 95% CI=0.84-1.04, p=0.21) and sustained cure rates (RR=0.93, 95% CI=0.83-1.05, p=0.26). For severe C. difficile infection the efficacy of vancomycin was superior to metronidazole in terms of clinical cure rates (RR=0.81, 95% CI=0.69-0.95, p=0.009), whereas sustained cure rates were similar (RR=0.86, 95% CI=0.72-1.02, p=0.08). Regarding microbiological cure metronidazole therapy was as effective as vancomycin therapy (RR=0.88, 95% CI=0.64-1.21, p=0.43). Recurrence rates with metronidazole and vancomycin for both mild C. difficile infection (RR=0.95, 95% CI=0.56-1.60, p=0.85) and severe C. difficile infection (RR=1.27, 95% CI=0.85-1.91, p=0.25) were not different. Likewise, no difference in all-cause mortality was found as well (RR=0.87, 95% CI=0.56-1.35, p=0.53). In conclusion, vancomycin provides improved initial clinical and sustained cure rates in patients with C. difficile infection compared with metronidazole, especially in patients with severe C. difficile infection. In view of these data, vancomycin may be considered first line therapy for severe C. difficile infection.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.