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Lower vancomycin dose efficacious in C. difficile
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DENVER — A low dose of oral vancomycin for the treatment of Clostridium difficile was similar in efficacy to a high-dose treatment regimen, data presented here at the 2013 Interscience Conference on Antimicrobial Agents and Chemotherapy suggest.
According to Philip Chung, PharmD, of Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, N.Y., there are no data suggesting that higher doses of vancomycin — 250 mg or higher, every 6 hours — are any better than a lower dose of 125 mg given every 6 hours. However, many physicians often request the higher dose.
Philip Chung
“Since the establishment of our antimicrobial stewardship program, we have been educating providers about using a lower dose of vancomycin and establishing institutional guidelines suggesting the use of the lower dose regimen for severe C. difficile infections,” Chung said during a press conference. “Because of this change in practice, we wanted to look at clinical outcomes to see if this recommendation has had any effect on clinical outcome.”
Chung and colleagues conducted a retrospective chart review of patients treated with vancomycin between 2006 and 2010. The study included 197 patients who received the lower dose of vancomycin and 103 patients who received a higher dose. The patients’ characteristics, risk factors for C. difficile, severity of infection and antibiotic use before and after infection were similar between the groups.
After 72 hours, clinical improvement after receiving treatment was seen in 85% of the low-dose group and 86% of the high-dose group. At the end of therapy or discharge, the rates of clinical improvement were 93% in the low-dose group and 96% in the high-dose group. There also were no significant differences between the two groups regarding in-hospital mortality, re-treatment and 30-day mortality due to all-cause or C. difficile infection.
“The goal of antimicrobial stewardship programs is to limit exposure to antibiotics without affecting clinical outcomes,” Chung said. “We used less of the drug with similar efficacy, and certainly one of the benefits to this is cost savings. For the most part, implementing the lower dose was well received by prescribing physicians.”
For more information:
Chung P. #K-335. Presented at: ICAAC 2013; Sept. 10-13; Denver.
Disclosure: Chung reports no relevant financial disclosures.