{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T17:33:02Z","timestamp":1770139982686,"version":"3.49.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T00:00:00Z","timestamp":1588032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Our objective was to determine if oral vancomycin, fidaxomicin, and oral metronidazole use in the United States changed after publication of revised clinical practice guidelines for Clostridium difficile infection (CDI) in February 2018.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We obtained US antibiotic prescription data (IQVIA) from 2006\u2013August 2019 and used guideline-recommended dosing regimens to estimate monthly numbers of 10-day treatment courses of vancomycin, fidaxomicin and metronidazole. Interrupted time-series analyses were performed, adjusted by month. We compared linear trends for monthly numbers of treatment courses in different time periods.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Cumulative treatment courses of oral vancomycin and fidaxomicin increased by 54% (n = 226 166) and 48% (n = 18 518), respectively, in 18 months following guidelines compared with 18 months before; those of oral metronidazole decreased by 3% (n = 238 372). Monthly vancomycin and fidaxomicin use significantly increased throughout the period following revised guidelines (P &amp;lt; .0001 and P = .0002, respectively), whereas that of metronidazole decreased significantly (P &amp;lt; .0001). Monthly vancomycin use increased and metronidazole use decreased to a significantly greater extent after publication of revised guidelines than after publication of clinical trials establishing superiority of vancomycin over metronidazole (P &amp;lt; .0001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Revised practice guidelines have had a significant impact on CDI treatment in the US. Clinical trial data used for the revised guidelines were available since 2007\u20132014 and 2011\u20132012 for oral vancomycin and fidaxomicin, respectively. Guidelines or guidance documents for treating CDI and other infections should be updated in more timely fashion.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa484","type":"journal-article","created":{"date-parts":[[2020,4,23]],"date-time":"2020-04-23T19:10:15Z","timestamp":1587669015000},"page":"1944-1949","source":"Crossref","is-referenced-by-count":39,"title":["Impact of Revised Infectious Diseases Society of America and Society for Healthcare Epidemiology of America Clinical Practice Guidelines on the Treatment of <i>Clostridium difficile<\/i> Infections in the United States"],"prefix":"10.1093","volume":"72","author":[{"given":"Cornelius J","family":"Clancy","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deanna","family":"Buehrle","sequence":"additional","affiliation":[{"name":"VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Vu","sequence":"additional","affiliation":[{"name":"VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilyn M","family":"Wagener","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M Hong","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,4,28]]},"reference":[{"key":"2021060106113087600_CIT0001","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"2021060106113087600_CIT0002","volume-title":"2017 Annual report for the Emerging Infections Program for Clostridioides difficile inf","author":"Centers for Disease Control and Prevention.","year":"2017"},{"key":"2021060106113087600_CIT0003","doi-asserted-by":"crossref","first-page":"ofx171","DOI":"10.1093\/ofid\/ofx171","article-title":"Risk factors for community-associated clostridium difficile infection in adults: a case-control study","volume":"4","author":"Guh","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2021060106113087600_CIT0004","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1086\/651706","article-title":"Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)","volume":"31","author":"Cohen","year":"2010","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2021060106113087600_CIT0005","doi-asserted-by":"crossref","first-page":"2850","DOI":"10.1093\/jac\/dkr377","article-title":"A randomized, double-blind, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection","volume":"66","author":"Garey","year":"2011","journal-title":"J Antimicrob Chemother"},{"key":"2021060106113087600_CIT0006","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1093\/cid\/ciy149","article-title":"Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)","volume":"66","author":"McDonald","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2021060106113087600_CIT0007","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/cid\/ciu313","article-title":"Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials","volume":"59","author":"Johnson","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2021060106113087600_CIT0008","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S1473-3099(11)70374-7","article-title":"Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial","volume":"12","author":"Cornely","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"2021060106113087600_CIT0009","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1056\/NEJMoa0910812","article-title":"Fidaxomicin versus vancomycin for Clostridium difficile infection","volume":"364","author":"Louie","year":"2011","journal-title":"N Engl J Med"},{"key":"2021060106113087600_CIT0010","author":"Wolters Kluwer Clinical Drug Information. 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