Oral Vancomycin for Secondary Prophylaxis of Clostridium difficile Infection
| Autor: | Nicole Bohm, Chase C Brown, Scott R Curry, Melanie M. Manis |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Clostridioides difficile business.industry Administration Oral Secondary prophylaxis 030204 cardiovascular system & hematology Clostridium difficile 030226 pharmacology & pharmacy Clostridium difficile infections Anti-Bacterial Agents 03 medical and health sciences 0302 clinical medicine Vancomycin Internal medicine Clostridium Infections Secondary Prevention medicine Humans Pharmacology (medical) business Oral vancomycin medicine.drug |
| Zdroj: | Annals of Pharmacotherapy. 53:396-401 |
| ISSN: | 1542-6270 1060-0280 |
| DOI: | 10.1177/1060028018815170 |
| Popis: | Objective: To summarize and critically appraise the evidence regarding oral vancomycin prophylaxis (OVP) to prevent recurrent Clostridium difficile infections (RCDIs), identify potential consequences of this emerging practice, and highlight future directions of study. Data Sources: A MEDLINE literature search of English-language publications from 1947 through September 2018 was performed using the search terms vancomycin and C difficile and prophylaxis. Clinical trials were identified on the National Library of Medicine clinical trials registry. Study Selection and Data Extraction: All clinical studies (n = 3) assessing oral vancomycin for secondary prophylaxis of C difficile infection (CDI) were evaluated by all authors. Other search results and references in selected publications were used for background and discussion. Data Synthesis: OVP reduced the risk of RCDI in high-risk patients taking systemic antibiotics. Variable dosing regimens and lack of safety data are limitations. OVP may have an adverse impact on the gastrointestinal microbiome, but this was not examined in the clinical studies. Relevance to Patient Care and Clinical Practice: Although current studies are limited by methodological concerns, clinicians can consider vancomycin 125 mg orally once or twice daily in high-risk patients receiving broad-spectrum antibacterial agents. Results of ongoing trials will define the most appropriate regimen and its impact on outcomes, including collateral damage. Conclusions: OVP reduces the risk of RCDIs and should be considered on a case-by-case basis. Caution is warranted before routine use is implemented because the impact on long-term outcomes has not been assessed and the optimal regimen has not been defined. |
| Databáze: | OpenAIRE |
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