David Hutt, MD
Hutt D.; Stopping an Epidemic of Clostridium difficile Diarrhea. Ann Intern Med. 1994;121:307. doi: 10.7326/0003-4819-121-4-199408150-00015
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Published: Ann Intern Med. 1994;121(4):307.
TO THE EDITOR:
Pear and colleagues  describe a nosocomial outbreak of Clostridium difficile-associated diarrhea that decreased promptly after clindamycin was removed from their formulary.
This conclusion would gain further credibility if the authors could provide data on hospital use of metronidazole before and after removal of clindamycin. In the sudden absence of clindamycin, one could easily imagine an abrupt increase in metronidazole use as an alternative for empiric or specific treatment of anaerobic infection. Because oral and intravenous metronidazole are active against C. difficile, an increase in the use of this agent could conceivably cause a reduced hospital burden of C. difficile organisms and thereby an observed decrease in the incidence of C. difficile-associated diarrhea.
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