Vancomycin or Metronidazole for Treatment of Clostridium difficile Infection: Clinical and Economic Analyses

Clostridium difficile (C. difficile) infection is the most common cause of nosocomial infectious diarrhea in adults. The spread of a hypervirulent strain of C. difficile has caused recent outbreaks of C. difficile infection. Metronidazole and vancomycin are the antibiotics of choice to treat C. difficile infection. An assessment was prepared to help guide the choice of therapy for C. difficile infection and to inform reimbursement policies in the Canadian publicly funded health care system.The research objectives were to evaluate the relative clinical effectiveness, the relative cost-effectiveness, and the budget impact of using vancomycin or metronidazole in the management of initial episodes of moderate to severe C. difficile infection in children or in adults. Clinical practice guidelines recommendations were also reviewed.