Oral vancomycin can help prevent recurrent C difficile infections

Dr Van Hise

Oral vancomycin (Vancocin) prophylaxis may be effective for the prevention of recurrent Clostridium difficile infection with minimal risk to the patient, according to a poster presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Nicholas Van Hise, PharmD, from the Indiana University Medical Center in Indianapolis, and colleagues studied 203 high-risk patients admitted to Mercy Hospital, St. Louis, from January 2010 to December 2012 who had a history of positive C difficile polymerase chain reaction (PCR) test and symptoms of infection. Data were collected on age, gender, race, and gastrointestinal (GI) suppression use.

Any patient that came into the hospital with a history of C difficile (defined as positive PCR with symptoms of C difficile infection) and received systemic antibiotics were separated into 2 groups. The groups are those patients who received oral vancomycin prophylaxis and those who did not receive oral vancomycin prophylaxis. These patients were then analyzed to determine the rate of breakthrough C difficile infection (defined as positive PCR with symptoms of C difficile infection).

Average age of patients in the study was 73 years; those who were not given prophylaxis averaged 69 years. Patients were almost evenly divided according to sex and about 80% were Caucasian, according to Dr Van Hise.

Patients were treated with 125 mg or 250 mg by mouth of prophylactic vancomycin twice a day.

“An oral vancomycin suspension was prepared using cherry-flavored syrup that can be formulated in the hospital pharmacy for little cost,” said Alex Bryant, PharmD, of Mercy Hospital and adjunct professor at the St. Louis College of Pharmacy.

The primary outcome was the absolute difference in the rate of high-risk patients who developed C difficile infection during or within the first 4 weeks following completion of antibiotic therapy, with and without prophylactic oral vancomycin.

The primary outcome was associated with a reduced incidence of C difficile development in the oral vancomycin group I (P=<.001).

According to Dr Van Hise, the subanalyses of the primary outcome demonstrated a benefit associated with oral vancomycin prophylaxis in the following:

• Patients ≥65 (P=.0003)

• GI suppression at home (P=<.001)

• GI suppression in hospital  (P=<.001)

• Multiple antibiotic classes including: Fluoroquinolones, aztreonam, cephalosporins, aminopenicillins, carbapenems, and the combination of vancomycin/pip/tazo/levofloxacin.

“Oral vancomycin prophylaxis was associated with a reduced incidence of recurrent C difficile infection in multiple high-risk patients receiving certain classes of broad spectrum antibiotics,” said Dr Van Hise.

“These results are pertinent since in today’s world, C difficile is associated with a 30% to 65% risk of recurrent C difficile infection once someone has had a primary infection. These recurrent C difficile infections typically occur while inpatient and being exposed to risk factors. If someone develops C. difficile infection while inpatient, this contributes to morbidity, infection control, hospital reimbursement, and possibly even mortality.” 

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