In the Journals

Long-duration vancomycin reduces C. diff recurrence in patients with IBD

Patients with inflammatory bowel disease who received long-duration vancomycin as treatment for Clostridioides difficile infection had lower recurrence rates compared with patients who received a shorter duration of the drug, according to study results.

David T. Rubin, MD, FACG, of the IBD Center at University of Chicago Medicine, and colleagues wrote that while previous studies shown vancomycin to be effective in patients with IBD as treatment for CDI, current C. diff guidelines do not specifically address patients with IBD.

“There are no definitive guidelines surrounding the choice of therapy and dosing of antibiotics for treatment of CDI in patients with IBD,” they wrote. “We hypothesized that patients with IBD treated with oral vancomycin for an extended amount of time have lower rates of recurrence and reinfection of CDI than those treated for a shorter duration.”

Researchers compared rates of CDI recurrence and reinfection among patients with Crohn’s disease or ulcerative colitis who received long-duration (defined as 21-42 days, n = 57) or short-duration (10-14 days, n = 77) vancomycin. They defined recurrence as positive C. diff toxin assay within 8 weeks of the end of antibiotic therapy and reinfection as positive C. diff after 8 weeks following the end of therapy.

Rubin and colleagues found that only one patient in the long-duration group experienced CDI recurrence (1.8%) compared with nine patients in the short-duration group (11.7%; P = .043). Treatment with long-duration vancomycin had lower odds for recurrence than the shorter duration (OR = 0.03; P = .021).

There was no difference in reinfection rates.

“It is clear that there is great need for an optimized therapy for CDI in patients with IBD, given their susceptibility to CDI and increased mortality, hospitalization and colectomy rates secondary to infection,” Rubin and colleagues wrote. “Our study, which shows lower rates of [recurrent] CDI in IBD cohorts treated with a longer duration of oral vancomycin compared with those treated for a shorter duration, is one step toward the eventual development of focused guidelines for CDI treatment in patients with IBD.” – by Alex Young

Disclosure s: Rubin reports serving as a consulting for and receiving grant support from AbbVie, Abgenomics, Allergan, Arena, Biomica, Bristol-Myers Squibb, Dizal, Ferring, Genentech/Roche, Janssen, Lilly, Mahana Therapeutics, Merck & Co, Medtronic, Napo, Pfizer, Shire, Target and Takeda. Please see the full study for all other authors’ relevant financial disclosures.

Patients with inflammatory bowel disease who received long-duration vancomycin as treatment for Clostridioides difficile infection had lower recurrence rates compared with patients who received a shorter duration of the drug, according to study results.

David T. Rubin, MD, FACG, of the IBD Center at University of Chicago Medicine, and colleagues wrote that while previous studies shown vancomycin to be effective in patients with IBD as treatment for CDI, current C. diff guidelines do not specifically address patients with IBD.

“There are no definitive guidelines surrounding the choice of therapy and dosing of antibiotics for treatment of CDI in patients with IBD,” they wrote. “We hypothesized that patients with IBD treated with oral vancomycin for an extended amount of time have lower rates of recurrence and reinfection of CDI than those treated for a shorter duration.”

Researchers compared rates of CDI recurrence and reinfection among patients with Crohn’s disease or ulcerative colitis who received long-duration (defined as 21-42 days, n = 57) or short-duration (10-14 days, n = 77) vancomycin. They defined recurrence as positive C. diff toxin assay within 8 weeks of the end of antibiotic therapy and reinfection as positive C. diff after 8 weeks following the end of therapy.

Rubin and colleagues found that only one patient in the long-duration group experienced CDI recurrence (1.8%) compared with nine patients in the short-duration group (11.7%; P = .043). Treatment with long-duration vancomycin had lower odds for recurrence than the shorter duration (OR = 0.03; P = .021).

There was no difference in reinfection rates.

“It is clear that there is great need for an optimized therapy for CDI in patients with IBD, given their susceptibility to CDI and increased mortality, hospitalization and colectomy rates secondary to infection,” Rubin and colleagues wrote. “Our study, which shows lower rates of [recurrent] CDI in IBD cohorts treated with a longer duration of oral vancomycin compared with those treated for a shorter duration, is one step toward the eventual development of focused guidelines for CDI treatment in patients with IBD.” – by Alex Young

Disclosure s: Rubin reports serving as a consulting for and receiving grant support from AbbVie, Abgenomics, Allergan, Arena, Biomica, Bristol-Myers Squibb, Dizal, Ferring, Genentech/Roche, Janssen, Lilly, Mahana Therapeutics, Merck & Co, Medtronic, Napo, Pfizer, Shire, Target and Takeda. Please see the full study for all other authors’ relevant financial disclosures.