From the Guidelines
For Clostridioides difficile infection when first-line treatments are unavailable, oral vancomycin (Vancocin) capsules should be dosed at 125 mg taken four times daily for 10 days. This regimen is effective for most non-severe and severe C. difficile infections, as recommended by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) in their 2021 focused update guidelines 1. For fulminant C. difficile infection, the dose may be increased to 500 mg four times daily, often with the addition of intravenous metronidazole. Vancomycin works by inhibiting bacterial cell wall synthesis and is not systemically absorbed when given orally, allowing it to reach high concentrations in the intestinal lumen where the infection resides. This targeted action effectively eliminates C. difficile while minimizing systemic side effects. Patients should complete the full course of treatment even if symptoms improve before completion to prevent recurrence. If the patient experiences recurrence after treatment, a tapered and pulsed regimen may be considered, starting with 125 mg four times daily for 10-14 days, followed by gradually decreased frequency over several weeks.
Some key points to consider when treating C. difficile infection with vancomycin include:
- The importance of completing the full treatment course to prevent recurrence
- The potential need for a tapered and pulsed regimen in cases of recurrence
- The consideration of alternative treatments, such as fidaxomicin or metronidazole, in certain cases
- The recommendation to use vancomycin 500 mg four times daily for fulminant C. difficile infection, as supported by the IDSA and SHEA guidelines 1.
It's worth noting that while other studies, such as the 2014 European Society of Clinical Microbiology and Infectious Diseases update, provide additional guidance on treating C. difficile infection 1, the most recent and highest-quality study, the 2021 IDSA and SHEA guidelines, should be prioritized when making treatment decisions 1.
From the FDA Drug Label
The recommended dose is 125 mg administered orally 4 times daily for 10 days.
The dosing for vancomycin (Vancocin) capsules for the treatment of Clostridioides difficile infection is 125 mg orally 4 times daily for 10 days 2.
- Adults: 125 mg orally 4 times daily for 10 days.
- Pediatric Patients (less than 18 years of age): 40 mg/kg in 3 or 4 divided doses for 7 to 10 days, not to exceed 2 g per day 2.
From the Research
Vancomycin Capsule Dosing for Clostridioides difficile Infection
- The recommended dosing for vancomycin capsules for the treatment of Clostridioides difficile infection is 125 mg four times daily 3, 4, 5.
- Some studies have compared the efficacy of different vancomycin dosing regimens, including high-dose (500 mg four times daily) and low-dose (125 mg four times daily) regimens 3, 5.
- The results of these studies suggest that the low-dose regimen (125 mg four times daily) is as effective as the high-dose regimen (500 mg four times daily) for the treatment of Clostridioides difficile infection 5.
- Additionally, a study found that vancomycin 125 mg once daily was effective in preventing further relapse in elderly patients with frequently relapsing C. difficile 6.
- It is worth noting that vancomycin dosing regimens may vary depending on the specific clinical context and patient population, and that the optimal dosing regimen may depend on various factors, including disease severity and patient comorbidities 3, 4, 5.
Key Considerations
- Vancomycin is generally well-tolerated, but adverse events can occur, and patients should be monitored closely during treatment 4, 5.
- The development of resistance to vancomycin is a concern, and alternative treatments may be necessary in cases where resistance is suspected or confirmed 7.
- Fecal microbiota transplantation (FMT) may be considered in patients who have failed vancomycin treatment or have recurrent C. difficile infection 6.