From the Research
Vancomycin is not recommended for routine prophylaxis against Clostridioides difficile (C. diff) infection. Despite vancomycin's effectiveness as a treatment for active C. diff infection, prophylactic use is generally avoided due to concerns about promoting antimicrobial resistance, particularly vancomycin-resistant enterococci (VRE) 1, 2, 3, 4, 5. The primary prevention strategies for C. diff should instead focus on:
- Antimicrobial stewardship (limiting unnecessary antibiotic use)
- Infection control measures (hand hygiene, contact precautions)
- Environmental cleaning
In very specific high-risk situations, such as patients with multiple recurrences requiring additional courses of antibiotics, some clinicians might consider prophylactic vancomycin at 125 mg orally daily, but this remains controversial and is not supported by strong evidence 1. The best approach to C. diff prevention remains limiting exposure to antibiotics that disrupt normal gut flora and implementing strict infection control practices. Fecal microbiota transplantation (FMT) has emerged as a promising therapy for recurrent CDI, with success rates of over 85% compared with less than 50% with antibiotics for multiple recurrent CDI 2, 4, 5.
The most recent and highest quality study, a randomized trial published in 2019, found that FMT was superior to fidaxomicin and vancomycin for treatment of recurrent C. diff infection 5. Therefore, FMT should be considered as a treatment option for recurrent C. diff infection, rather than prophylactic vancomycin. It is essential to weigh the risks and benefits of any treatment approach and consider the latest evidence when making clinical decisions.