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Long-duration treatment with vancomycin for Clostridioides difficile infections (CDIs) is associated with significantly lower rates of infection recurrence when compared with short-duration treatment, according to study results published in the American Journal of Gastroenterology.
Patients with inflammatory bowel disease (IBD) are susceptible to CDIs. Practice guidelines for the management of CDI issued by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America suggest either vancomycin or fidaxomicin over metronidazole for the treatment of an initial episode of CDI. However, there are still no definitive guidelines on therapy choice and antibiotic dosing for CDI in IBD. This study sought to determine whether patients with IBD had lower rates of CDI recurrence or reinfection when treated for a short duration of 10 to 14 days compared with a long duration of 21 to 42 days.
Researchers performed a retrospective chart review of patients from the University of Chicago Medicine who had a confirmed diagnosis of IBD with at least 1 positive C difficile toxin assay between 2010 and 2016. Patients were split into groups based on whether they received long-duration vancomycin therapy or short-duration vancomycin therapy. CDI recurrence and reinfection were defined as a positive C difficile toxin assay by polymerase chain reaction within 8 weeks of the end of therapy and after 8 weeks of the end of therapy, respectively. The primary outcome was CDI recurrence.
134 patients with IBD met inclusion criteria for the study. Of these patients, 57 had ulcerative colitis and 77 had Crohn disease. Long-duration vancomycin and short-duration vancomycin were used to treat 57 patients and 77 patients, respectively.
Only 1 patient in the long-duration group had CDI recurrence (1.8%) compared with 9 patients in the short-duration group (11.7%, odds ratio [OR] 0.13; P = .043). There was no difference observed in CDI reinfection rates between the long-duration group and the short-duration group (14% vs 16.9%, respectively). Multivariate logistic regression models showed that patients treated with long-duration vancomycin had lower recurrence odds than patients treated with short-duration vancomycin (OR 0.03; P =.021).
The study had 2 possible limitations. First, researchers were unable to control for aspects of patient cases that may have been biased based on whether they received long-duration or short-duration vancomycin therapy. Second, the cohort was too small to allow researchers to compare long-duration vancomycin treatment with standard protocols using other treatment regimens.
The researchers concluded that when compared with short-duration vancomycin therapy for the treatment of CDI, long-duration vancomycin therapy was associated with significantly lower CDI recurrence rates.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
References
Lei DK, Ollech JE, Andersen M, et al. Long-duration oral vancomycin to treat Clostridioides difficile in patients with inflammatory bowel disease is associated with a low rate of recurrence. Am J Gastroenterol. 2019;114(12):1904-1908.
