Comparison of Oral Vancomycin Capsule and Solution for Treatment of Initial Episode of Severe Clostridium difficile Infection

2013 ◽  
Vol 28 (2) ◽  
pp. 183-188 ◽  
Author(s):  
Stephanie N. Bass ◽  
Simon W. Lam ◽  
Seth R. Bauer ◽  
Elizabeth A. Neuner
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Clinical Cure ◽  
Primary Objective ◽  
Oral Solution ◽  
Oral Vancomycin ◽  
First Line Therapy ◽  
Initial Episode ◽  
Outcome Differences ◽  
Severe Clostridium Difficile Infection

Objective: Vancomycin is recommended as a first-line therapy for severe Clostridium difficile infection (CDI). Due to the high cost of commercially available vancomycin capsules, hospitals frequently compound oral solution despite a lack of data comparing outcomes. This study was conducted to determine treatment outcome differences based on oral vancomycin formulation. Methods: Medical charts of 76 patients with an initial episode of severe CDI receiving oral vancomycin as a commercially available capsule or a compounded oral solution for at least 72 hours were retrospectively reviewed. The primary objective was to compare the time to clinical cure of CDI. Results: Baseline characteristics between groups were similar except for the median lactate, which was higher in compounded oral solution group (1.5 vs 0.6 mmol/L, P < .001). There was no difference in clinical cure at day 10 (64% solution vs 59% capsules, P = .664). Median time to clinical cure was 8 days for solution and 7 for capsules ( P = .597). After adjustment, the hazard ratio of time to clinical cure for solution compared to capsules was 1.15 ( P = .69). No significant differences in mortality, recurrence, or complications were noted. Conclusion: Formulation of oral vancomycin did not impact treatment outcomes in this retrospective study.

scholarly journals Initial Oral Vancomycin vs. Oral Vancomycin After Metronidazole for Severe Clostridium difficile Infection

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S390-S390
Author(s):  
Sunish Shah ◽  
Benjamin Ereshefsky ◽  
Laura Pontiggia ◽  
Michael Cawley
Keyword(s):  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Clostridium Difficile Infection ◽  
Post Infection ◽  
Clinical Cure ◽  
Oral Vancomycin ◽  
End Of Treatment ◽  
Severe Clostridium Difficile Infection ◽  
The Impact ◽  
Length Of Hospitalization

Abstract Background Treatment of severe Clostridium difficile infection (CDI) with oral vancomycin (oVAN) is known to be superior to treatment with metronidazole. However, previous studies have not evaluated the impact on patients when oVAN therapy is delayed after diagnosis or suspicion of severe CDI. Methods This was a single-center, retrospective study of adult patients who were diagnosed with severe CDI as defined by a white blood cell (WBC) count greater than 15,000 cells/mm3. The primary outcome was in-hospital mortality between patients treated initially with oVAN vs. delayed oVAN after metronidazole. Secondary outcomes included clinical cure by day 10, post-infection length of hospitalization, the time to resolution of leukocytosis and renal function at the end of treatment. Leukocytosis was defined as a WBC greater than 12,000 cells/mm3. Patients were excluded if they received oVAN for a previous episode of CDI, were receiving treatment for a concurrent infection, were receiving high-dose steroids, or received metronidazole or oVAN within 5 days preceding CDI diagnosis. Results A total of 121 patients were included. Overall, 49% of patients were female and the median age was 67 years old. 101 patients comprised the initial oVAN group, while 20 patients comprised the delayed oVAN group. Baseline demographics did not differ significantly between groups other than the time to initiation of oVAN (0.33 vs. 3.18 days, P &lt; 0.001). There was no significant difference in in-hospital mortality for patients in the initial oVAN treatment group compared with those who had delayed oVAN therapy (5% vs. 15%, P = 0.13). Patients who received oVAN initially experienced a higher rate of clinical cure by day 10 (49.5% vs. 20%, P = 0.02), a shorter median post-infection length of hospitalization (7 days vs. 13 days, P &lt; 0.001), a shorter median time to resolution of leukocytosis (3.9 days vs. 10.4 days, P = 0.01), and were less likely to have an end of treatment serum creatinine greater than 1.5 times their baseline (8.7% vs. 29.4%, P = 0.03). Conclusion Patients who receive oVAN as their initial treatment for severe CDI have improved clinical outcomes compared with those initially treated with metronidazole. Disclosures All authors: No reported disclosures.

scholarly journals Oral teicoplanin for successful treatment of severe refractory Clostridium difficile infection

2015 ◽  
Vol 9 (10) ◽  
pp. 1062-1067 ◽  
Author(s):  
Natasa Popovic ◽  
Milos Korac ◽  
Zorica Nesic ◽  
Branko Milosevic ◽  
Aleksandar Urosevic ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Combination Therapy ◽  
Clostridium Difficile Infection ◽  
Clinical Cure ◽  
Oral Vancomycin ◽  
Clinical Center ◽  
Significant Difference ◽  
Cure Time ◽  
Severe Clostridium Difficile Infection ◽  
One Year

Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin. Methodology: A one-year prospective study was carried out in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia. Patients with severe and complicated CDI who failed to respond to oral vancomycin and intravenous metronidazole combination therapy were enrolled. They were given oral teicoplanin 100 mg bi-daily. Patients were followed for recurrence for eight weeks. Results: Nine patients with a mean age of 70.8±9.4 years were analyzed. All patients had pseudomembranous colitis, and five had complicated disease. In four patients intracolonic delivery of vancomycin was also performed in addition to oral vancomycin and intravenous metronidazole prior to initiating teicoplanin, but without improvement. After teicoplanin initiation all patients achieved clinical cure. The mean time to resolution of diarrhoea after teicoplanin introduction was 6.3±4.5 days. There was no statistically significant difference in time to resolution of diarrhoea according to initial leucocyte count, age over 65 years, the presence of ileus, complicated disease and the use of concomitant antibiotic therapy (p = 0.652, 0,652, 0.374, 0.374, and 0,548, respectively). None of the patients experienced recurrence. Conclusions: Oral teicoplanin might be a potential treatment for severe and complicated refractory CDI, but further studies are required.

scholarly journals Intravenous Tigecycline Facilitates Cure of Severe Clostridium difficile Infection (CDI) After Failure of Standard Therapy: A Case Report and Literature Review of Tigecycline Use in CDI

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Bhagyashri D. Navalkele ◽  
Stephen A. Lerner
Keyword(s):  
Septic Shock ◽  
Case Report ◽  
Clostridium Difficile ◽  
Literature Review ◽  
Clostridium Difficile Infection ◽  
Standard Treatment ◽  
Fecal Transplant ◽  
Oral Vancomycin ◽  
Standard Regimen ◽  
Severe Clostridium Difficile Infection

Abstract Standard treatment for severe Clostridium difficile infection (CDI) is oral vancomycin with metronidazole. After failure of this standard regimen, treatment becomes challenging. A young woman treated for septic shock developed CDI. Standard treatment failed and she was ineligible for fecal transplant. Addition of tigecycline to her regimen resulted in cure.

scholarly journals Impact of Delayed Oral Vancomycin for Severe Clostridium difficile Infection

2018 ◽  
Vol 54 (5) ◽  
pp. 294-299 ◽  
Author(s):  
Sunish Shah ◽  
Benjamin Ereshefsky ◽  
Laura Pontiggia ◽  
Michael Cawley
Keyword(s):  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Clostridium Difficile Infection ◽  
Initial Treatment ◽  
Oral Vancomycin ◽  
End Of Treatment ◽  
Significant Difference ◽  
Severe Clostridium Difficile Infection ◽  
The Impact

Background: Treatment of severe Clostridium difficile infection (CDI) with oral vancomycin (VAN) is known to be superior to treatment with metronidazole (MDZ). However, previous studies have not evaluated the impact on patients when oral VAN therapy is delayed after diagnosis of severe CDI. Materials and Methods: This was a single-center, retrospective study of adult patients who were diagnosed with severe CDI. The objective was to compare clinical outcomes for patients treated initially with oral VAN versus patients receiving delayed oral VAN after at least 48 hours of initial treatment with MDZ. The primary outcome was all-cause in-hospital mortality. Results: There were 101 patients who comprised the initial oral VAN group, while 20 patients comprised the delayed oral VAN group. There was no significant difference in all-cause in-hospital mortality for patients in the initial oral VAN treatment group compared to those who had delayed oral VAN therapy (4.95% vs 15.00%, P = 0.13). Patients who were initially treated with oral VAN experienced a significantly higher rate of clinical cure (49.50% vs 20.00%, P = 0.02), shorter median postinfection length of hospitalization (7.0 days vs 13.0 days, P < 0.001), shorter median time to resolution of leukocytosis (3.9 days vs 10.4 days, P = 0.01), and were less likely to have an end of treatment serum creatinine greater than 1.5 times their baseline (8.7% vs 29.4%, P = 0.03). Conclusion: Patients who receive oral VAN as their initial treatment for severe CDI experience improved clinical outcomes compared to patients receiving delayed oral VAN after being initially treated with MDZ.

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