番茄社区

WASHINGTON -- Prophylaxis with oral vancomycin (Vancocin) appeared to protect at-risk patients from experiencing a recurrence of Clostridium difficile infection, researchers reported here.

In a retrospective review of cases, one of 71 patients (1%) given prophylaxis with oral vancomycin, paired with antibiotic therapy, experienced recurrence of C. difficile compared with 35 (37%) out of 132 patients not given the prophylaxis (P<0.001), said , from the University of Indiana Medical School in Indianapolis, and colleagues.

"It doesn't taste real great, but patients tolerate it, because they would rather have the drug than another bout of C. difficile," co-author from Mercy Hospital St. Louis, told 番茄社区 in discussing the group's poster presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Bryant said patients are considered high risk for C. difficile recurrence if they are in the hospital for another illness or surgery that required antibiotic therapy, over age 65, or have been exposed to immunosuppressive treatments or illnesses. In all of those cases, and antibiotic treatment in particular, the gut flora can be compromised and the patient becomes at risk for C. difficile.

The goal of the study was to determine if secondary prophylaxis with oral vancomycin impacted the incidence of recurrent C. difficile infection in high-risk patients.

High-risk patients admitted to Mercy Hospital from January 2010 to December 2012 were included. All 203 patients had a history of positive C. difficile polymerase chain reaction test and symptoms of infection. Data were collected on age, gender, race, and gastrointestinal (GI) suppression use.

The patients in the study arm were about 73-years-old while those who were not given prophylaxis had an average age of 69 (P=0.0745). The patients were nearly evenly divided by sex and about 80% were Caucasian.

Patients were treated with 125 mg of prophylactic vancomycin twice a day. An oral vancomycin suspension was prepared using a cherry flavored syrup, Van Hise told 番茄社区, adding that "the oral suspension can be formulated in the hospital pharmacy for very little cost."

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 subanalyses of the primary outcome demonstrated a benefit associated with oral vancomycin prophylaxis in the following:

• Patients ≥65 (P=0.0003)
• GI suppression at home (P=0.0002)
• GI suppression in hospital (P=0.0001)

Another subanalysis of antibiotic classes "found significance in favor of oral [prophylactic] vancomycin prophylaxis for aminopenicillins, fluoroquinolones, aztreonam, vancomycin, cephalosporins, and the combination of vancomycin/piperacillin-tazobactam/levofloxacin. No significant difference was found for other antibiotic classes," the authors wrote.

Bryant noted that his group did not come across specific adverse events with the use of oral prophylactic vancomycin, but those types of events might emerge in a large clinical trial setting.

"A prospective study could potentially further stratify patients at highest risk who would benefit most from secondary prevention," the group concluded.

, agreed that a prospective clinical trial would be helpful in determining how well the oral vancomycin regimen works.

"This is interesting research," said Nailor, an associate clinical professor of infectious diseases at the University of Connecticut/Hartford Hospital in Hartford.

Nailor was not involved in this study but pointed out that "we use the same regimen in treating our patients, but we have not performed this analysis. There is also the question as to whether the patients who develop a recurrence do not return to the hospital or are treated elsewhere."

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