Bálint Strbák

A Clostridium difficile-fertozések antibiotikum- terápiája. A tudományos bizonyítékok szisztematikus áttekintése és metaanalízise

Bevezetes: A Clostridium difficile az antibiotikum asszocialta hasmenesek leggyakoribb korokozoja, aminek kezelesere az elmult evtizedekben keves uj szer kerult kifejlesztesre, es a tudomanyos bizonyitekok korlatozott mertekben es nehezen osszehasonlithato modon allnak rendelkezesre. Celkitűzes: A Clostridium difficile okozta fertőzes terapiajanak hatasossagi es biztonsagossagi vegpontjainak elemzese a metronidazol, vancomycin es a fidaxomicin alkalmazasa eseten. Modszer: A szakirodalom attekintese es az eredmenyek metaanalizise. Eredmenyek: A metaanalizis szerint a klinikai gyogyulas vegpontban nincs szignifikans kulonbseg a harom terapia kozott (eselyaranyok: fidaxomicin vs. vancomycin 1,19, vancomycin vs. metronidazol 1,69 es fidaxomicin vs. metronidazol 2,00). A rekurrencia es a globalis gyogyulas vegpontokban a fidaxomicin szignifikansan hatasosabbnak bizonyult, mint a vancomycin es a metronidazol (eselyaranyok: fidaxomicin vs. vancomycin 0,47, vancomycin vs. metronidazol 0,91 es fidaxomicin vs. metr...INTRODUCTION Clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. Limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of Clostridium difficile infection. The available scientific evidence is limited and hardly comparable. AIM To analyse the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of Clostridium difficile infection. METHODS Systematic review and meta-analysis of the literature data. RESULTS Meta-analysis of literature data showed no significant difference between these antibiotics in clinical cure endpoint (odss ratios: fidaxomicin vs. vancomycin 1.19; vancomycin vs. metronidazol 1.69 and fidaxomicin vs. metronidazol 2.00). However, fidaxomicin therapy was significantly more effective than vancomicin and metronidazol in endpoints of recurrence and global cure (odds ratios: fidaxomicin vs. vancomycin 0.47; vancomycin vs. metronidazol 0.91 és fidaxomicin vs. metronidazol 0.43). There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints. CONCLUSIONS Each antibiotic similarly improved clinical cure. Fidaxomicin was the most effective therapeutic alternative in lowering the rate of recurrent Clostridium difficile infections.

[Clostridium difficile infection: epidemiology, disease burden and therapy].

INTRODUCTION C. difficile causes 25 percent of the antibiotic associated infectious nosocomial diarrhoeas. C. difficile infection is a high-priority problem of public health in each country. The available literature of C. difficile infections epidemiology and disease burden is limited. AIM Review of the epidemiology, including seasonality and the risk of recurrences, of the disease burden and of the therapy of C. difficile infection. METHOD Review of the international and Hungarian literature in MEDLINE database using PubMed up to and including 20th of March, 2012. RESULTS The incidence of nosocomial C. difficile associated diarrhoea is 4.1/10 000 patient day. The seasonality of C. difficile infection is unproved. 20 percent of the patients have recurrence after metronidazole or vancomycin treatment, and each recurrence increases the chance of a further one. The cost of C. difficile infection is between 130 and 500 thousand HUF (430 € and 1665 €) in Hungary. CONCLUSIONS The importance of C. difficile infection in public health and the associated disease burden are significant. The available data in Hungary are limited, further studies in epidemiology and health economics are required.

Antimicrobial therapy ofClostridium difficileinfection. Systematic literature review and meta-analysis

Bevezetes: A Clostridium difficile az antibiotikum asszocialta hasmenesek leggyakoribb korokozoja, aminek kezelesere az elmult evtizedekben keves uj szer kerult kifejlesztesre, es a tudomanyos bizonyitekok korlatozott mertekben es nehezen osszehasonlithato modon allnak rendelkezesre. Celkitűzes: A Clostridium difficile okozta fertőzes terapiajanak hatasossagi es biztonsagossagi vegpontjainak elemzese a metronidazol, vancomycin es a fidaxomicin alkalmazasa eseten. Modszer: A szakirodalom attekintese es az eredmenyek metaanalizise. Eredmenyek: A metaanalizis szerint a klinikai gyogyulas vegpontban nincs szignifikans kulonbseg a harom terapia kozott (eselyaranyok: fidaxomicin vs. vancomycin 1,19, vancomycin vs. metronidazol 1,69 es fidaxomicin vs. metronidazol 2,00). A rekurrencia es a globalis gyogyulas vegpontokban a fidaxomicin szignifikansan hatasosabbnak bizonyult, mint a vancomycin es a metronidazol (eselyaranyok: fidaxomicin vs. vancomycin 0,47, vancomycin vs. metronidazol 0,91 es fidaxomicin vs. metr...INTRODUCTION Clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. Limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of Clostridium difficile infection. The available scientific evidence is limited and hardly comparable. AIM To analyse the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of Clostridium difficile infection. METHODS Systematic review and meta-analysis of the literature data. RESULTS Meta-analysis of literature data showed no significant difference between these antibiotics in clinical cure endpoint (odss ratios: fidaxomicin vs. vancomycin 1.19; vancomycin vs. metronidazol 1.69 and fidaxomicin vs. metronidazol 2.00). However, fidaxomicin therapy was significantly more effective than vancomicin and metronidazol in endpoints of recurrence and global cure (odds ratios: fidaxomicin vs. vancomycin 0.47; vancomycin vs. metronidazol 0.91 és fidaxomicin vs. metronidazol 0.43). There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints. CONCLUSIONS Each antibiotic similarly improved clinical cure. Fidaxomicin was the most effective therapeutic alternative in lowering the rate of recurrent Clostridium difficile infections.

Antimicrobial therapy of Clostridium difficile infection. Systematic literature review and meta-analysis

Bevezetes: A Clostridium difficile az antibiotikum asszocialta hasmenesek leggyakoribb korokozoja, aminek kezelesere az elmult evtizedekben keves uj szer kerult kifejlesztesre, es a tudomanyos bizonyitekok korlatozott mertekben es nehezen osszehasonlithato modon allnak rendelkezesre. Celkitűzes: A Clostridium difficile okozta fertőzes terapiajanak hatasossagi es biztonsagossagi vegpontjainak elemzese a metronidazol, vancomycin es a fidaxomicin alkalmazasa eseten. Modszer: A szakirodalom attekintese es az eredmenyek metaanalizise. Eredmenyek: A metaanalizis szerint a klinikai gyogyulas vegpontban nincs szignifikans kulonbseg a harom terapia kozott (eselyaranyok: fidaxomicin vs. vancomycin 1,19, vancomycin vs. metronidazol 1,69 es fidaxomicin vs. metronidazol 2,00). A rekurrencia es a globalis gyogyulas vegpontokban a fidaxomicin szignifikansan hatasosabbnak bizonyult, mint a vancomycin es a metronidazol (eselyaranyok: fidaxomicin vs. vancomycin 0,47, vancomycin vs. metronidazol 0,91 es fidaxomicin vs. metr...INTRODUCTION Clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. Limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of Clostridium difficile infection. The available scientific evidence is limited and hardly comparable. AIM To analyse the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of Clostridium difficile infection. METHODS Systematic review and meta-analysis of the literature data. RESULTS Meta-analysis of literature data showed no significant difference between these antibiotics in clinical cure endpoint (odss ratios: fidaxomicin vs. vancomycin 1.19; vancomycin vs. metronidazol 1.69 and fidaxomicin vs. metronidazol 2.00). However, fidaxomicin therapy was significantly more effective than vancomicin and metronidazol in endpoints of recurrence and global cure (odds ratios: fidaxomicin vs. vancomycin 0.47; vancomycin vs. metronidazol 0.91 és fidaxomicin vs. metronidazol 0.43). There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints. CONCLUSIONS Each antibiotic similarly improved clinical cure. Fidaxomicin was the most effective therapeutic alternative in lowering the rate of recurrent Clostridium difficile infections.