To the Editor.
—We applaud the recent Editorial by Drs Spera and Farber,1 which should increase awareness of the growing problem of multiply-resistant Enterococcus faecium. We agree that limitation of the use of antimicrobial agents that select for growth of these strains should be a major element of infection control practice. However, one of their specific recommendations deserves further comment. They state that "oral metronidazole should become the treatment of choice for colitis due to Clostridium difficile since it has efficacy equal to that of oral vancomycin and is much more cost-effective."We believe that metronidazole has an important role in the treatment of mildly to moderately ill patients with C difficile colitis. The largest prospective, randomized trial to date of metronidazole vs vancomycin for C difficile—associated diarrhea did show the drugs equally effective in such patients.2 However, only 30% of the patients treated in that study
Caputo GM, Weitekamp MR. The Treatment of Clostridium difficile Colitis. JAMA. 1993;269(16):2088. doi:10.1001/jama.1993.03500160054029