From the FDA Drug Label
The bactericidal action of vancomycin against Staphylococcus aureus and the vegetative cells of Clostridium difficile results primarily from inhibition of cell-wall biosynthesis. In subjects with diarrhea resolution at end-of-treatment with Vancomycin Hydrochloride Capsules, recurrence of CDAD during the following four weeks occurred in 25 of 107 (23%) and 18 of 102 (18%) in Trial 1 and Trial 2, respectively.
There is no information in the provided drug label that directly supports a recommendation for a prophylactic measure to prevent recurrence of C. diff infection in a 50+ year old male with a history of C. diff infection, currently asymptomatic, considering a new drug compared to vancomycin. The FDA drug label does not answer the question.
From the Research
Prophylactic treatment for C. difficile infection is not recommended in asymptomatic patients, even with a history of previous infection, as it may lead to antibiotic resistance or unnecessary side effects, and the best approach is watchful waiting and monitoring for symptoms of recurrence 1. The patient currently has no symptoms of C. difficile recurrence, so prescribing either vancomycin or a new drug would be inappropriate. Some key points to consider in this scenario include:
- The risk of antibiotic resistance, particularly with the use of vancomycin and other broad-spectrum antibiotics, which can lead to the development of resistant strains of C. difficile 2, 1.
- The importance of monitoring for symptoms of recurrence, such as diarrhea, and seeking medical attention if they develop 3, 4.
- The need for evidence-based guidelines in managing patients with a history of C. difficile infection who are currently asymptomatic, which prioritize watchful waiting and monitoring over prophylactic treatment 1, 5. Key considerations for managing C. difficile infection include:
- Limiting the use of broad-spectrum antibiotics to reduce the risk of developing C. difficile infection 3, 4.
- Implementing infection control measures, such as proper hand hygiene and isolation precautions, to prevent the spread of C. difficile 2, 5.
- Using antimicrobial susceptibility testing to guide treatment decisions and minimize the risk of antibiotic resistance 1, 5.