Sir.—We would like to report an error in one of the most referenced antimicrobial therapy handbooks for the pediatric patient.1 On page 45, Dr Nelson recommends vancomycin hydrochloride as the drug of choice for the treatment of antibiotic-associated pseudomembranous colitis (AAPC) caused by Clostridium difficile both by oral and parenteral routes of administration.1 Although the oral form of vancomycin, as well as that of metronidazole, is known to be effective in the treatment of AAPC, very limited information has been reported in regard to the efficacy of the intravenous route for either of these drugs.
A literature search on the subject yielded only one success with intravenous vancomycin hydrochloride,2 and several failures.3-6 Similarly, lack of effectiveness with intravenous metronidazole has been reported4,6; however, metronidazole hydrochloride has superior intestinal tissue penetration compared with vancomycin as a result of enterohepatic recirculation and may account for limited
OH T, DE OCA GM, OSORNO RJ. Antibiotic-Associated Pseudomembranous Colitis. Am J Dis Child. 1990;144(5):526. doi:10.1001/archpedi.1990.02150290020016
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