Is oral vancomycin prophylaxis (OVP) effective in preventing recurrent Clostridium difficile infection (CDI) in patients requiring systemic antimicrobial therapy (SAT)?

Although OVP is often administered to patients with history of CDI who require SAT, evidence to support this practice has been lacking until recently. In a retrospective study of 203 patients who received either OVP (125 mg or 250 mg 2x/daily) during the course of their SAT and up to 1 week thereafter vs no OVP,  CDI rate was significantly lower in the OVP group (4.2% vs 26.6%, respectively, O.R. 0.12 [C.I. 0.04-0.4]) (1). The mean age was 73 y (41-97 y), the mean interval between prior CDI and initiation of prophylaxis was 6.1 months (1-21 months), and the mean duration of prophylaxis following discontinuation of SAT was 1 day (0-6 days) in the OVP group.

Despite its retrospective nature, this study lends support to the use of OVP in reducing the risk of recurrent CDI in patients who require SAT. It is unclear how long OVP should be continued after SAT, if at all, but common practice is 1-2 weeks. More studies are clearly needed.

Disclosure: The author of this post is also a coauthor of the study cited.

 

Reference

  1. Van Hise NW, Bryant AM, Hennessey EK, Crannage AJ, Khoury JA, Manian FA. Efficacy of oral vancomycin in preventing recurrent Clostridium difficile infection in patients treated with systemic antimicrobial agents. Clin Infect Dis 2016; Advance Access published June 17, 2016. Doi.10.1093/cid/ciw401.
Is oral vancomycin prophylaxis (OVP) effective in preventing recurrent Clostridium difficile infection (CDI) in patients requiring systemic antimicrobial therapy (SAT)?

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