REPLY
Stopping an Epidemic of Clostridium difficile Diarrhea
Suzanne M. Pear, RN;
John N. Galgiani, MD; and
Dale N. Gerding
15 August 1994 | Volume 121 Issue 4 | Pages 307-308
IN RESPONSE:
We reviewed the use of metronidazole and other antimicrobial agents for the 9 months before and after clindamycin was removed. Through June 1991, 309 ±30 g of metronidazole were used per month compared with 343 ±26 g per month thereafter. These differences were not significant (P > 0.2, Kruskal-Wallis test). Similarly, no significant increases were noted in the use of penicillin, imipenem, or ticarcillin-clavulanate; in vitro susceptibility testing had indicated that the epidemic-associated J7 strain of Clostridium difficile was sensitive to these other drugs. There was an increase in use of amoxicillin-clavulanate (Beecham, Philadelphia, Pennsylvania) and ampicillin-sulbactam (Unasyn, Roerig Inc., New York, New York) that was probably related to the restriction of clindamycin. The J7 strain was sensitive to amoxicillin-clavulanate, and we presumed that the J7 strain would also have been found to be susceptible to ampicillin-sulbactam, had it been tested. However, the increased use of these drug combinations did not occur until several months after our epidemic of C. difficile-associated diarrhea ended. Thus, it does not seem that increased use of any of these antimicrobials was responsible for our success.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Article
