-
Views
-
Cite
Cite
Dale N. Gerding, Antimotility Agents for the Treatment of Clostridium difficile Infection: Is the Juice Worth the Squeeze?, Clinical Infectious Diseases, Volume 48, Issue 5, 1 March 2009, Pages 606–608, https://doi.org/10.1086/596712
Close - Share Icon Share
Extract
In this issue of Clinical Infectious Diseases, Koo et al. [1] present a literature review from which they conclude that there is a lack of evidence supporting the hypothesis that worsened Clostridium difficile infection (CDI) outcomes can result from use of antimotility drugs. The authors' conclusion is not based on lack of evidence of deleterious outcomes associated with use of antimotility drugs, but rather on the basis of lack of adverse events when the antimotility drugs were administered together with specific metronidazole or vancomycin treatment for CDI. The population in the literature of such patients treated with both antibiotics and antimotility agents is small (only 23 patients), and all of the patients are from a single retrospective study conducted in England by Wilcox and Howe [2] that involved patients seen during 1991–1993. That article is often cited for its conclusion that treatment response in CDI is slower with metronidazole than with vancomycin. The authors are careful to mention that there was no difference in the duration of CDI symptoms associated with the use of antimotility agents, irrespective of antibiotic therapy. Presumably, the authors were making this point to assure readers that the difference in time to clinical response between metronidazole and vancomycin that they found was not attributable to the use of antimotility agents, which might have skewed their study results. Can we conclude from evidence in this single study that there is no adverse risk to the use of antimotility agents to treat CDI if given with antibiotics? And if so, are there potential benefits to the use of antimotility agents that might outweigh the possible risks?
