Comparative effectiveness of metronidazole and vancomycin for treatment of infection in hospitalized children.
Thomas J Sandora, Timothy J Savage, Morgan E Ryan, Suzanne E Dahlberg, Kaitlyn Daugherty, Ciar��n P Kelly, Nira R Pollock, Larry K Kociolek
Author Information
Thomas J Sandora: Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. ORCID
Timothy J Savage: Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Morgan E Ryan: Biostatistics Research and Design Center, Boston Children's Hospital, Boston, MA, USA. ORCID
Suzanne E Dahlberg: Biostatistics Research and Design Center, Boston Children's Hospital, Boston, MA, USA.
Kaitlyn Daugherty: Division of Gastroenterology (K.D., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. ORCID
Ciar��n P Kelly: Division of Gastroenterology (K.D., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Nira R Pollock: Division of Gastroenterology (K.D., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Larry K Kociolek: Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Objective: To compare rates of clinical response in children with infection (CDI) treated with metronidazole vs vancomycin. Design: Retrospective cohort study was performed as a secondary analysis of a previously established prospective cohort of hospitalized children with CDI. For 187 participants 2-17 years of age who were treated with metronidazole and/or vancomycin, the primary outcome of clinical response (defined as resolution of diarrhea within 5 days of treatment initiation) was identified retrospectively. Baseline variables associated with the primary outcome were included in a logistic regression propensity score model estimating the likelihood of receiving metronidazole vs vancomycin. Logistic regression using inverse probability of treatment weighting (IPTW) was used to estimate the effect of treatment on clinical response. Results: One hundred seven subjects received metronidazole and 80 subjects received vancomycin as primary treatment. There was no univariable association between treatment group and clinical response; 78.30% (N = 83) of the metronidazole treatment group and 78.75% (N = 63) of the vancomycin group achieved clinical response ( = 0.941). After adjustment using propensity scores with IPTW, the odds of a clinical response for participants who received metronidazole was 0.554 (95% CI: 0.272, 1.131) times the odds of those who received vancomycin ( = 0.105). Conclusions: In this observational cohort study of pediatric inpatients with CDI, the rate of resolution of diarrhea after 5 days of treatment did not differ among children who received metronidazole vs vancomycin.
