From the Guidelines
Vancomycin is an acceptable alternative for treating Clostridioides difficile (C. diff) infection, but fidaxomicin is the preferred therapy due to its improved sustained response after therapy.
Role of Vancomycin in C. diff Treatment
- Vancomycin remains an acceptable alternative for initial and recurrent C. diff episodes, especially when fidaxomicin is not available 1.
- The recommended dose of vancomycin for C. diff treatment is 125 mg given 4 times daily by mouth for 10 days for initial episodes and 500 mg 4 times daily by mouth or by nasogastric tube for fulminant CDI 1.
- Vancomycin can also be used in a tapered and pulsed regimen for recurrent CDI episodes, with a regimen example of 125 mg 4 times daily for 10–14 days, 2 times daily for 7 days, once daily for 7 days, and then every 2 to 3 days for 2 to 8 weeks 1.
Comparison with Fidaxomicin
- Fidaxomicin is preferred over vancomycin for initial and recurrent C. diff episodes due to its improved sustained response after therapy and lower recurrence rates 1.
- Fidaxomicin has a narrow spectrum of activity and minimal systemic absorption, making it an attractive therapy for C. diff infection 1.
Clinical Practice Guidelines
- The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) recommend fidaxomicin as the preferred therapy for initial C. diff episodes, with vancomycin as an acceptable alternative 1.
- For recurrent CDI episodes, fidaxomicin (standard or extended-pulsed regimen) is suggested, with vancomycin in a tapered and pulsed regimen or as a standard course as acceptable alternatives 1.
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. Vancomycin has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections [see Indications and Usage (1)]. Anaerobic gram-positive bacteria: Clostridium difficile isolates associated with C. difficile associated bacteria.
The role of Vancomycin in treating Clostridioides difficile (C. diff) infection is as a bactericidal agent that inhibits cell-wall biosynthesis, ultimately leading to the death of the bacteria.
- Key points:
- Vancomycin is active against most isolates of C. difficile.
- The drug works by inhibiting cell-wall biosynthesis.
- It is used to treat C. difficile-associated diarrhea (CDAD) 2. Vancomycin is effective in treating C. diff infection, with clinical success rates ranging from 80.8% to 81.3% in clinical trials 2.
From the Research
Vancomycin Treatment for C. diff Infection
- Vancomycin is a recommended treatment for Clostridioides difficile infection (CDI) [(3,4,5)].
- The optimal dose of vancomycin for CDI treatment has not been fully established, with studies suggesting no significant difference in treatment outcomes between high-dose and low-dose vancomycin [(3,5)].
- However, one study found that vancomycin may be more effective than metronidazole in treating severe CDI cases 4.
Comparison with Other Treatments
- Fidaxomicin and vancomycin are both recommended as first-line therapies for CDI, with fidaxomicin associated with a lower risk of recurrence 6.
- Vancomycin and metronidazole have similar effects on the risk of vancomycin-resistant Enterococci (VRE) 7.
Dosage and Efficacy
- Low-dose vancomycin (<2 g per day) may be as effective as high-dose vancomycin (2 g per day) for treating initial episodes of non-fulminant CDI 5.
- Higher doses of oral vancomycin may be associated with lower rates of recurrence, although this requires further investigation 3.
Clinical Considerations
- The choice of vancomycin dose and treatment duration should be individualized based on patient factors and disease severity [(3,4,5)].
- Clinicians should be aware of the potential risks and benefits of vancomycin treatment, including the risk of VRE 7.