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Extended duration vancomycin in recurrent Clostridium difficile infection: a systematic review
Madison M Murphy1, Edna Patatanian2, Mark A Gales2
1The University of Kansas Health System Kansas City, KS, USA.
Therapeutic Advances in Infectious Disease
|November 16, 2018
Summary
Extended duration vancomycin (EDV) is crucial for recurrent Clostridium difficile infections (rCDI). Taper and pulse regimens show superior outcomes compared to pulse-only methods for treating rCDI.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Clostridium difficile infections (CDI) frequently recur after initial treatment.
- Extended duration vancomycin (EDV) is a primary therapy for recurrent CDI (rCDI).
- Current clinical guidelines for rCDI treatment lack robust evidence.
Purpose of the Study:
- To review the safety and efficacy of extended duration vancomycin regimens for treating recurrent Clostridium difficile infections.
- To evaluate outcomes data from published studies on EDV for rCDI.
Main Methods:
- Systematic review of five articles (three case series, two randomized open-label trials).
- Analysis of data from 174 patients with recurrent CDI.
- Evaluation of vancomycin dosing, therapy duration, and follow-up periods.
Main Results:
- Case series reported EDV success rates from 61% to 100%.
- Randomized trials indicated lower success rates, ranging from 26% to 58%.
- Taper and pulse regimens demonstrated better outcomes (58-100%) than pulse-only regimens (26-81%).
Conclusions:
- Comparative data on EDV regimens is limited.
- Current evidence supports EDV regimens incorporating a daily taper followed by pulsed dosing (every 48-72 hours) for rCDI.
- Further high-quality research is needed to optimize EDV strategies.
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