From the FDA Drug Label
In two trials, Vancomycin Hydrochloride Capsules 125 mg orally four times daily for 10 days was evaluated in 266 adult subjects with C. difficile-associated diarrhea (CDAD)
The FDA drug label does not answer the question of how long vancomycin therapy should be continued after antibiotics for C. diff prophylaxis, as the label only discusses the treatment of CDAD, not prophylaxis.
From the Research
Vancomycin therapy should be continued for at least 8 weeks after antibiotics for C. diff prophylaxis in high-risk patients, such as those with previous C. diff infections or immunocompromised status, as evidenced by a study published in 2019 1. The recommended prophylactic regimen is oral vancomycin 125 mg once daily, which has been shown to be effective in preventing further relapse in elderly patients with frequently relapsing C. difficile 1. Some studies suggest that vancomycin prophylaxis may be considered in patients who have failed fecal microbiota transplantation (FMT) or in cases where FMT is not available 1. However, other studies have reported that prophylactic vancomycin is an effective strategy to prevent CDI recurrence, but it increases the risk of vancomycin-resistant enterococcal (VRE) colonization 2. It's worth noting that the duration of vancomycin prophylaxis may vary depending on the individual patient's risk factors and medical history, and the decision to extend prophylaxis should be made on a case-by-case basis. Key points to consider when deciding on the duration of vancomycin prophylaxis include:
- The patient's history of C. diff infections and response to previous treatments
- The patient's immunocompromised status and overall health
- The risk of VRE colonization and other potential side effects
- The availability and feasibility of alternative treatments, such as FMT. Overall, the decision to continue vancomycin therapy for C. diff prophylaxis should be based on a careful assessment of the individual patient's risks and benefits, and should be guided by the most recent and highest-quality evidence available 3, 4.