Fucidic Acid Use in Metronidazole Nonresponders with Clostridium difficile Infection

to our out-patient clinic with existing diarrhea in whom C. difficile toxin A was detected at stool examination. All patients except the one with metranidazole allergy had a history of prior metranidazole use for C. difficile -associated diarrhea (CDAD). On the 10th day of treatment stool examination for C. difficile toxin A was negative for all cases. Patient characteristics are presented in table 1 . At the end of the treatment period, clinical symptoms of CDAD have been resolved and no recurrence of infection has been reported during the follow-up period. Previous reports have suggested that diarrheal relapses of IBD may be associated or confused with enteric infection. Stool studies yielded a pathogen, mainly C. Dear Sir, Clostridium difficile is the major identifiable etiologic agent of antibiotic-associated diarrhea and colitis [1] . Its clinical presentation ranges from asymptomatic carriage to toxic megacolon which requires surgical resection. The impact of C. difficile on patients with inflammatory bowel diseases (IBD) is still unknown at the present time. Recent reports have shown that the rate of C. difficile infection in IBD patients has increased [2] . It may be either an innocent bystander or a micro-organism that could play a role in IBD relapse. We used fucidic acid orally for 10 days at a dose of 1,500 mg/day in 5 patients (3 with ulcerative colitis, 1 with Crohn’s disease, 1 with chronic diarrhea who was diagnosed as Crohn’s disease later) admitted Published online: August 8, 2007