From the FDA Drug Label
Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea. C. difficile-associated diarrhea: The recommended dose is 125 mg administered orally 4 times daily for 10 days.
The recommended prophylactic dose of vancomycin for patients with a history of C. diff who are prescribed antibiotics is not explicitly stated in the provided drug label. The label only provides dosage information for the treatment of C. difficile-associated diarrhea. 1
From the Research
For patients with a history of Clostridioides difficile (C. diff) infection who require antibiotics, the recommended prophylactic dose of oral vancomycin is 125 mg once daily, continued throughout the course of antibiotic therapy and for 5-7 days after completion of the antibiotics. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 2. The vancomycin works by maintaining adequate concentrations in the gut to prevent C. diff spore germination and toxin production while the normal gut microbiome is disrupted by the other antibiotics. Some key points to consider when prescribing prophylactic vancomycin include:
- The importance of identifying high-risk patients who have had multiple recurrences of C. diff infection or those with significant risk factors for recurrence, such as advanced age, immunosuppression, or exposure to high-risk antibiotics like fluoroquinolones, clindamycin, or broad-spectrum cephalosporins 3, 4.
- Alternative options, such as fidaxomicin 200 mg once daily or bezlotoxumab (a single IV dose) in conjunction with standard antibiotic treatment, may be considered for patients who are at high risk of recurrence or who have had multiple previous C. diff episodes 5, 6.
- The use of vancomycin as a prophylactic measure is supported by studies that demonstrate its efficacy in reducing the risk of recurrence and improving outcomes in patients with C. diff infection 2. It's essential to weigh the benefits and risks of prophylactic vancomycin and consider individual patient factors, such as the severity of the underlying infection, the presence of comorbidities, and the potential for adverse effects, when making treatment decisions.