Utilizing Oral Vancomycin for Clostridioides Difficile Prophylaxis

Clostridioides difficile infection (CDI) continues to be a challenging and common healthcare associated infection (HAI) where patients can experience reccurence.

It’s been estimated that approximately 15% to 30% of patients who respond to antibiotics experience recurrent CDI.¹ A second recurrence rate of 40% has been reported among patients with a resolved first recurrence.¹ And unfortunately, a subset of these patients will experience additional recurrences and this can become a revolving door of healthcare interactions, diminished quality of life, and severe health consequences.

Over the last decade there has been the emergence of studies looking at oral vancomycin prophylaxis.

Andrew Darkow, PharmD, MBA, BCPS clinical assistant professor, Campbell University College of Pharmacy & Health Sciences, internal medicine clinical pharmacist, Duke Regional Hospital, and coinvestigators looked at the available literature around OVP and wanted to see the efficacy and safety using this approach and determine if they could offer some clinical guidance when prescribing OVP.

Darkow and colleagues reviewed these past studies and their findings were published in Current Infectious Disease Reports.

There was a total of 12 studies, with 4 of them looking at primary prophlaxis and 8 of them for secondary prophlaxis.

“Most of them demonstrate a benefit in using OVP by reducing CDI occurrence or recurrence,” Darkow stated.

He does point out that 11 of the 12 studies were retrospective with the remaining one a prospective study.

In terms of which patients are the most likely candidates for OVP, Darkow and his coinvestigators say the studies do not clearly define them, but they offer some suggestions.

“The mostly retrospective and heterogeneous nature of the currently available evidence makes it difficult to draw definitive conclusions as to when OVP should be utilized and who may benefit most from its use,” the investigators wrote. “High-risk patient populations (elderly, immunocompromised, and those expected to have a prolonged hospitalization) who are receiving parenteral antibiotics may be reasonable to target for OVP.”

Contagion spoke to Darkow about their findings, looking at potential candidates for OVP, and whether treatment guidelines should be updated.

Reference

1. Song JH, Kim YS. Recurrent Clostridium difficile Infection: Risk Factors, Treatment, and Prevention. Gut Liver. 2019;13(1):16-24. doi:10.5009/gnl18071