Oral vancomycin may prevent recurrent C. difficile
Secondary prophylactic oral vancomycin in addition to concomitant antibiotics appears to prevent further recurrence of Clostridium difficile infection among patients with a history of recurrence.
These results show that “when administered simultaneously with an antibiotic treatment not targeting C. difficile following a recent CDI diagnosis, oral vancomycin is an effective protection strategy against CDI recurrence but only in patients who have already experienced at least one CDI relapse before their additional exposure to antibiotics,” Alex Carignan, MD, MSc, from the department of microbiology and infectious diseases at the University of Sherbrooke in Quebec, told Healio Gastroenterology.
Carignan and colleagues evaluated 551 patients who were diagnosed with CDI at two tertiary care centers in Quebec between 2003 and 2011, all of whom received antibiotics not targeting CDI within 90 days of their CDI diagnosis. Three hundred seventy-nine of the cases were initial CDI episodes, and 172 were recurrent CDIs. The investigators performed Cox regression analyses to identify risk factors for CDI recurrence following this exposure to non-CDI antibiotics.
CDI recurrence occurred in 32.9% of cases, and was more likely to occur in older patients (adjusted HR = 1.01; 95% CI, 1-1.03 for each additional year; P = .02). Recurrent CDI was also more likely to occur in patients for whom the CDI episode after exposure to non-CDI antibiotics was their first recurrence (aHR = 3.59; 95% CI, 2.52-5.13; P < .0001) or second recurrence (aHR = 4.88; 95% CI, 3.38-7.06; P < .0001).
Among those patients whose CDI after antibiotic exposure was itself a recurrent CDI, prophylactic oral vancomycin reduced the risk for further recurrence (aHR = 0.47; 95% CI, 0.32-0.69; P < .0001), but did not reduce the risk for further recurrence among patients whose CDI after antibiotic exposure was an initial CDI episode.
“These results are reassuring, given that several clinicians have adopted this practice, despite the limited supportive data so far,” Carignan said. “This practice also has a very low cost for hospitals, because oral vancomycin is formulated in hospital pharmacy. This antibiotic also has limited systemic absorption, limiting adverse effects for patients.”
While the retrospective nature of this study cannot rule out potential bias, its results “open the gate for further randomized controlled trials,” he added. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.