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Stopping an Epidemic of Clostridium difficile Diarrhea
- Suzanne M. Pear, RN;
- John N. Galgiani, MD; and
- Dale N. Gerding
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IN RESPONSE:
We reviewed the use of metronidazole and other antimicrobial agents for the 9 months before and after clindamycin was removed. Through June 1991, 309 ±30 g of metronidazole were used per month compared with 343 ±26 g per month thereafter. These differences were not significant (P > 0.2, Kruskal-Wallis test). Similarly, no significant increases were noted in the use of penicillin, imipenem, or ticarcillin-clavulanate; in vitro susceptibility testing had indicated that the epidemic-associated J7 strain of Clostridium difficile was sensitive to these other drugs. There was an increase in use of amoxicillin-clavulanate (Beecham, Philadelphia, Pennsylvania) and ampicillin-sulbactam (Unasyn, Roerig Inc., New York, New York) that was probably related to the restriction of clindamycin. The J7 strain was sensitive to amoxicillin-clavulanate, and we presumed that the J7 strain would also have been found to be susceptible to ampicillin-sulbactam, had it been tested. However, the increased use of these drug combinations did not occur until several months after our epidemic of C. difficile-associated diarrhea ended. Thus, it does not seem that increased use of any of these antimicrobials was responsible for our success.
- Copyright ©2004 by the American College of Physicians
