From the Guidelines
After vancomycin is discontinued by another provider, you should first determine why it was stopped before taking any action, and if the discontinuation was premature or inappropriate, consult with the provider who stopped it to understand their reasoning. If the discontinuation was appropriate, such as completion of therapy, negative cultures, or resolution of infection, no further action is needed. However, if you believe the discontinuation was premature or inappropriate, review the patient's clinical status, culture results, antibiotic susceptibilities, and indication for initial therapy. According to the most recent guidelines 1, the treatment of Clostridioides difficile infection (CDI) depends on the severity and recurrence of the disease. For a first episode of CDI, the recommended treatment is metronidazole 500 mg tid PO for 10 days or vancomycin 125 mg qid PO for 10 days, with a strong recommendation and high quality of evidence.
Key Considerations
- The patient's clinical status and culture results should be reviewed to determine the best course of action.
- If vancomycin is still clinically indicated, discuss restarting it with the healthcare team, potentially at a dose of 125 mg qid PO for 10 days, as recommended by the guidelines 1.
- Monitor for adverse effects, including nephrotoxicity, if therapy is resumed.
- Fecal microbiota transplantation is recommended for patients with multiple recurrences of CDI who have failed appropriate antibiotic treatments, with a strong recommendation and moderate quality of evidence 1.
Next Steps
- Consult with the provider who stopped the vancomycin to understand their reasoning.
- Review the patient's clinical status, culture results, antibiotic susceptibilities, and indication for initial therapy.
- Discuss restarting vancomycin with the healthcare team, if clinically indicated.
- Consider alternative treatment options, such as fidaxomicin or fecal microbiota transplantation, if necessary.
From the Research
Next Steps After Vancomycin Discontinuation
- Review the patient's medical record to understand the reason for vancomycin discontinuation and the current treatment plan 2.
- Check the patient's lab results, including culture reports, to determine if there are any signs of infection or resistance to other antibiotics 3.
- Consider consulting with the antimicrobial stewardship team or an infectious disease specialist to determine the best course of action for the patient's treatment 4.
Considerations for Vancomycin Use
- Vancomycin is typically used to treat serious staphylococcal infections, streptococcal endocarditis, and other infections caused by gram-positive bacteria 5.
- The decision to discontinue vancomycin should be based on clinical judgment and consideration of the patient's individual needs and circumstances 3.
- In some cases, vancomycin may be discontinued if the patient has a negative MRSA nasal and throat culture and a low clinical pulmonary infection score (CPIS) 4.
Potential Complications of Vancomycin Use
- Vancomycin can cause hypersensitivity reactions, including drug rash with eosinophilia and systemic symptoms (DRESS syndrome), which can lead to acute renal failure 6.
- Monitoring for signs of vancomycin-induced nephrotoxicity and ototoxicity is essential, especially in patients with pre-existing renal or hearing impairment 5.