What is the role of Vancomycin (Vancomycin) prophylaxis for Clostridioides difficile (C. diff) infection in patients receiving other antibiotics?

From the Guidelines

Vancomycin prophylaxis is not routinely recommended for patients on antibiotics to prevent Clostridioides difficile (C. diff) infection, but it may be considered for high-risk patients with a history of recurrent C. diff infections. The primary approach to preventing C. diff infection should focus on antibiotic stewardship, using antibiotics only when necessary and selecting the narrowest spectrum agent for the shortest effective duration 1. For patients who require antibiotics for another infection and have a history of recurrent C. diff, oral vancomycin prophylaxis at 125 mg once daily may be considered during and for 5-7 days after completion of the other antibiotic therapy 1. This is based on the understanding that disruption of normal gut flora by antibiotics creates an environment where C. diff can proliferate, and vancomycin can suppress C. diff growth during this vulnerable period. However, this practice should be limited to high-risk patients due to concerns about promoting vancomycin-resistant organisms and further disrupting gut microbiota.

Some key points to consider in the management and prevention of C. diff infection include:

• Antibiotic exposure is a major risk factor for C. diff infection, and stewardship activities should aim to minimize unnecessary antibiotic use 1
• Host factors such as immune status, co-morbidities, and age over 65 years also play a significant role in the risk of developing C. diff infection 1
• Preventive measures such as strict hand hygiene, contact precautions for infected patients, and environmental cleaning are crucial in reducing C. diff transmission 1
• The treatment of C. diff infection should be based on the severity of the disease, with antibiotic therapy being the first choice, and the molecule choice should be based on the severity of the disease 1

It's essential to weigh the benefits and risks of vancomycin prophylaxis in individual patients, considering their specific risk factors and medical history. The decision to use vancomycin prophylaxis should be made on a case-by-case basis, taking into account the potential benefits of preventing C. diff infection and the potential risks of promoting vancomycin-resistant organisms and disrupting gut microbiota.

From the FDA Drug Label

Vancomycin is an antibacterial drug The bactericidal action of vancomycin against Staphylococcus aureus and the vegetative cells of Clostridium difficile results primarily from inhibition of cell-wall biosynthesis.

The role of Vancomycin prophylaxis for Clostridioides difficile (C. diff) infection in patients receiving other antibiotics is to treat C. difficile-associated diarrhea (CDAD). Vancomycin has been shown to be active against most isolates of Clostridium difficile. However, the provided drug labels do not directly address the use of Vancomycin as a prophylactic measure for C. diff infection in patients receiving other antibiotics. Therefore, no conclusion can be drawn regarding its prophylactic use in this context 2 2.

From the Research

Vancomycin Prophylaxis for C. diff Infection

• The use of vancomycin as a prophylactic measure to prevent Clostridioides difficile (C. diff) infection in patients receiving other antibiotics has been studied in several clinical trials 3, 4.
• A study published in 2019 found that oral vancomycin prophylaxis (OVP) reduced the risk of recurrent C. diff infections (RCDIs) in high-risk patients taking systemic antibiotics 3.
• The study suggested that vancomycin 125 mg orally once or twice daily may be considered in high-risk patients receiving broad-spectrum antibacterial agents, but cautioned that the impact on long-term outcomes has not been assessed and the optimal regimen has not been defined 3.
• Another study published in 2018 updated treatment algorithms for C. diff infection and proposed that oral vancomycin will become the first choice when antibiotic treatment for C. diff infection is necessary 4.
• The study also suggested that vancomycin combined with faecal microbiota transplantation remains the primary therapy for multiple recurrent C. diff infection 4.

Probiotics as an Alternative

• Probiotics have also been studied as a potential prophylactic measure to prevent C. diff infection in patients receiving antibiotics 5, 6, 7.
• A systematic review and meta-analysis published in 2017 found that probiotics reduced the risk of C. diff-associated diarrhea (CDAD) by 60% in adults and children 7.
• The review found that the use of probiotics was effective in preventing CDAD, particularly in trials with a baseline risk of CDAD > 5% 7.
• However, the review also noted that the quality of the evidence was moderate, and further research is needed to confirm the findings 7.

Comparison of Vancomycin and Probiotics

• Both vancomycin and probiotics have been shown to be effective in preventing C. diff infection in patients receiving antibiotics 3, 7.
• However, vancomycin is an antibiotic and may have adverse effects on the gut microbiota, whereas probiotics are live microbial preparations that confer a health benefit to the host 3, 7.
• The choice between vancomycin and probiotics as a prophylactic measure may depend on the individual patient's risk factors and medical history 3, 7.