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. 1986 Oct;27(10):1169–1172. doi: 10.1136/gut.27.10.1169

Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile.

R P Bolton, M A Culshaw
PMCID: PMC1433873  PMID: 3781329

Abstract

Faecal metronidazole and hydroxymetronidazole concentrations measured by high pressure liquid chromatography are reported during 10 episodes of Clostridium difficile colitis in nine patients. Bactericidal faecal concentrations were present in all patients with acute disease receiving oral or intravenous metronidazole, and all responded to therapy. Metronidazole and hydroxymetronidazole concentrations fell as the diarrhoea improved and neither substance was detectable in the faeces of five patients after recovery. This demonstration of intracolonic therapeutic concentrations of metronidazole supports the clinical experience of oral metronidazole being effective in the treatment of antibiotic associated diarrhoea caused by C difficile and also suggests a potential role for intravenous metronidazole in this disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bartlett J. G., Taylor N. S., Chang T., Dzink J. Clinical and laboratory observations in Clostridium difficile colitis. Am J Clin Nutr. 1980 Nov;33(11 Suppl):2521–2526. doi: 10.1093/ajcn/33.11.2521. [DOI] [PubMed] [Google Scholar]
  2. Brown J. R. Metronidazole and antibiotic-associated colitis. Br Med J (Clin Res Ed) 1981 Nov 14;283(6302):1334–1334. doi: 10.1136/bmj.283.6302.1334. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cherry R. D., Portnoy D., Jabbari M., Daly D. S., Kinnear D. G., Goresky C. A. Metronidazole: an alternate therapy for antibiotic-associated colitis. Gastroenterology. 1982 May;82(5 Pt 1):849–851. [PubMed] [Google Scholar]
  4. Daly J. J., Chowdary K. V. Pseudomembranous colitis secondary to metronidazole. Dig Dis Sci. 1983 Jun;28(6):573–574. doi: 10.1007/BF01308162. [DOI] [PubMed] [Google Scholar]
  5. Fekety R., Silva J., Buggy B., Deery H. G. Treatment of antibiotic-associated colitis with vancomycin. J Antimicrob Chemother. 1984 Dec;14 (Suppl 500):97–102. doi: 10.1093/jac/14.suppl_d.97. [DOI] [PubMed] [Google Scholar]
  6. Fekety R., Silva J., Toshniwal R., Allo M., Armstrong J., Browne R., Ebright J., Rifkin G. Antibiotic-associated colitis: effects of antibiotics on Clostridium difficile and the disease in hamsters. Rev Infect Dis. 1979 Mar-Apr;1(2):386–397. doi: 10.1093/clinids/1.2.386. [DOI] [PubMed] [Google Scholar]
  7. George W. L., Rolfe R. D., Finegold S. M. Treatment and prevention of antimicrobial agent-induced colitis and diarrhae. Gastroenterology. 1980 Aug;79(2):366–372. [PubMed] [Google Scholar]
  8. Gordon R. S. Metronidazole or vancomycin for Clostridium difficile associated diarrhoea. Lancet. 1983 Dec 17;2(8364):1417–1417. doi: 10.1016/s0140-6736(83)90941-8. [DOI] [PubMed] [Google Scholar]
  9. Ings R. M., McFadzean J. A., Ormerod W. E. The fate of metronidazole and tis implications in chemotherapy. Xenobiotica. 1975 Apr;5(4):223–235. doi: 10.3109/00498257509052069. [DOI] [PubMed] [Google Scholar]
  10. Keighley M. R., Burdon D. W., Arabi Y., Williams J. A., Thompson H., Youngs D., Johnson M., Bentley S., George R. H., Mogg G. A. Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea. Br Med J. 1978 Dec 16;2(6153):1667–1669. doi: 10.1136/bmj.2.6153.1667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Krook A., Lindström B., Kjellander J., Järnerot G., Bodin L. Relation between concentrations of metronidazole and Bacteroides spp in faeces of patients with Crohn's disease and healthy individuals. J Clin Pathol. 1981 Jun;34(6):645–650. doi: 10.1136/jcp.34.6.645. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Nicolopoulos N. G., Stathapoulos E. N., Douzinas E. E., Vassilakis J. S. Pseudomembranous colitis. Treatment by metronidazole. Hepatogastroenterology. 1981 Apr;28(2):120–122. [PubMed] [Google Scholar]
  13. Nielsen M. L., Justesen T. Excretion of metroindazole in human bile. Investigations of hepatic bile, common duct bile, and gallbladder bile. Scand J Gastroenterol. 1977;12(8):1003–1008. doi: 10.3109/00365527709181365. [DOI] [PubMed] [Google Scholar]
  14. Oldenburger D., Miller J. A. Treatment of pseudomembranous colitis with oral metronidazole after relapse following vancomycin. Am J Gastroenterol. 1980 Oct;74(4):359–360. [PubMed] [Google Scholar]
  15. Pashby N. L., Bolton R. P., Sherriff R. J. Oral metronidazole in Clostridium difficile colitis. Br Med J. 1979 Jun 16;1(6178):1605–1606. doi: 10.1136/bmj.1.6178.1605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Populaire P., Benazet F., Pascal S., Lebreton G., Decouvelaere B., Guillaume L. Circulation et sort du métronidazole dans le tractus digestif chez le rat après administration par voie orale. Absorption du métronidazole par les muqueuses digestives. Therapie. 1971 May-Jun;26(3):581–594. [PubMed] [Google Scholar]
  17. Rampling A., Warren R. E., Berry P. J., Swirsky D., Hoggarth C. E., Bevan P. C. Atypical Clostridium difficile colitis in neutropenic patients. Lancet. 1982 Jul 17;2(8290):162–163. doi: 10.1016/s0140-6736(82)91135-7. [DOI] [PubMed] [Google Scholar]
  18. Teasley D. G., Gerding D. N., Olson M. M., Peterson L. R., Gebhard R. L., Schwartz M. J., Lee J. T., Jr Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet. 1983 Nov 5;2(8358):1043–1046. doi: 10.1016/s0140-6736(83)91036-x. [DOI] [PubMed] [Google Scholar]
  19. Tedesco F., Markham R., Gurwith M., Christie D., Bartlett J. G. Oral vancomycin for antibiotic-associated pseudomembranous colitis. Lancet. 1978 Jul 29;2(8083):226–228. doi: 10.1016/s0140-6736(78)91741-5. [DOI] [PubMed] [Google Scholar]
  20. Trnka Y. M., Lamont J. T. Clostridium difficile colitis. Adv Intern Med. 1984;29:85–107. [PubMed] [Google Scholar]

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