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Letters |15 August 1994

Stopping an Epidemic of Clostridium difficile Diarrhea

Suzanne M. Pear, RN; John N. Galgiani, MD; Dale N. Gerding

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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.
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Pear SM, Galgiani JN, Gerding DN. Stopping an Epidemic of Clostridium difficile Diarrhea. Ann Intern Med. ;121:307–308. doi: 10.7326/0003-4819-121-4-199408150-00030

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Published: Ann Intern Med. 1994;121(4):307-308.

DOI: 10.7326/0003-4819-121-4-199408150-00030

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