Oral teicoplanin for successful treatment of severe refractory Clostridium difficile infection

  • Natasa Popovic Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
  • Milos Korac Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
  • Zorica Nesic School of Medicine, University of Belgrade, Belgrade, Serbia
  • Branko Milosevic Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
  • Aleksandar Urosevic Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
  • Djordje Jevtovic Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
  • Mijomir Pelemis Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
  • Dragan Delic Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
  • Milica Prostran School of Medicine, University of Belgrade, Belgrade, Serbia
  • Ivana Milosevic Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia

Abstract

Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin.

Methodology: A one-year prospective study was carried out in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia. Patients with severe and complicated CDI who failed to respond to oral vancomycin and intravenous metronidazole combination therapy were enrolled. They were given oral teicoplanin 100 mg bi-daily. Patients were followed for recurrence for eight weeks.

Results: Nine patients with a mean age of 70.8±9.4 years were analyzed. All patients had pseudomembranous colitis, and five had complicated disease. In four patients intracolonic delivery of vancomycin was also performed in addition to oral vancomycin and intravenous metronidazole prior to initiating teicoplanin, but without improvement. After teicoplanin initiation all patients achieved clinical cure. The mean time to resolution of diarrhoea after teicoplanin introduction was 6.3±4.5 days. There was no statistically significant difference in time to resolution of diarrhoea according to initial leucocyte count, age over 65 years, the presence of ileus, complicated disease and the use of concomitant antibiotic therapy (p = 0.652, 0,652, 0.374, 0.374, and 0,548, respectively). None of the patients experienced recurrence.

Conclusions: Oral teicoplanin might be a potential treatment for severe and complicated refractory CDI, but further studies are required.

Author Biographies

Natasa Popovic, Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
Gastroenterolgy
Milos Korac, Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
Gastroenterology
Branko Milosevic, Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
Intensive Care Unit
Aleksandar Urosevic, Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
Intensive Care Unit
Ivana Milosevic, Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia
Gastroenterology
Published
2015-10-29
How to Cite
Popovic N, Korac M, Nesic Z, Milosevic B, Urosevic A, Jevtovic D, Pelemis M, Delic D, Prostran M, Milosevic I (2015) Oral teicoplanin for successful treatment of severe refractory Clostridium difficile infection. The Journal Of Infection In Developing Countries 9 (10): 1062-1067. https://doi.org/10.3855/jidc.6335
Section
Original Articles

Keywords

oral teicoplanin; Clostridium difficile; refractory pseudomembranous colitis; recurrence