P719 Metronidazol verus rifaximin in the treatment of Clostridium difficile infection in inflammatory bowel disease children: a randomized study.
A. Gawronska1, D. Lachowicz2, P. Obuch-Woszczatynski2, I. Lazowska-Przeorek1, K. Karolewska-Bochenek1, M. Kotowska1, H. Pituch2, P. Albrecht*1, A. Banaszkiewicz1
1Medical University of Warsaw, Dept. of Pediatric Gastroenterology and Nutrition, Warsaw, Poland, 2Medical University of Warsaw, Department of Medical Microbiology, Warsaw, Poland
Background
The aim of the study was to compare the effectiveness of metronidazole and rifaximin in the treatment of Clostridium difficile infection (CDI) in pediatric patients with inflammatory bowel disease (IBD).
Methods
We conducted a prospective, double-blinded, randomized trial with children age 12-18 years. Crohn's disease (CD) and ulcerative colitis (UC) were diagnosed according to Porto criteria. CDI diagnosis was based on a positive stool VIDAS® Clostridium difficile toxin A/B ELFA (bioMerieux, France) test. Patients were randomly assigned to receive metronidazole or rifaximin for 14 days; doses of drugs are presented in table below. Stool samples were collected before and 4 weeks after the end of treatment.
Table
| Body weight | Metronidazole, tabl. a 250 mg | Rifaximin tabl. a 200mg |
|---|---|---|
| 30–40 kg | 3 x 1 tabl. | 3 x 1 tabl. |
| 40–50 kg | 1-2-1 tabl. | 1-2-1 tabl. |
| 50–60 kg | 2-1-2 tabl. | 2-1-2 tabl. |
| >60 kg | 3 x 2 tabl. | 3 x 2 tabl. |
Results
In the present study, 26 patients were enrolled (mean age 14.3 years), including 9 with CD and 17 with UC. 14 received metronidazole and 12 received rifaximin. There were no statistically significant differences between study groups in age, gender and disease type. 4 weeks after the end of treatment Clostridium difficile toxins were found in 5/14 (36%) patients in metronidazole group and in 4/12 (33.3%) patients in rifaximin group (n=NS).
Conclusion
Metronidazole and rifaximin was equally effective in the treatment of CDI in pediatric patients with IBD.