Oral Vancomycin as Secondary Prophylaxis for Clostridioides difficile Infection

Area of Science:

• Infectious Diseases
• Pediatric Gastroenterology
• Pharmacology

Background:

• Secondary oral vancomycin prophylaxis (OVP) is used in adults to prevent recurrent Clostridioides difficile infection (CDI) during antibiotic therapy.
• The efficacy and safety of OVP in pediatric patients with a history of CDI have not been previously established.

Purpose of the Study:

• To evaluate the effectiveness of secondary OVP in preventing CDI recurrence in pediatric patients who have previously had CDI and are subsequently treated with systemic antibiotics.

Main Methods:

• A retrospective cohort study was conducted on pediatric patients (≤18 years) with a history of CDI who received systemic antibiotics between 2013-2019.
• Patients receiving OVP concurrently with antibiotics were compared to those not receiving OVP, with CDI recurrence within 8 weeks as the primary outcome.

Main Results:

• The study included 30 patients receiving OVP and 44 not receiving OVP. Patients on OVP had higher rates of antibiotic use and longer hospital stays.
• CDI recurrence was significantly lower in the OVP group (3% vs. 25%, P = .02), even with more risk factors for recurrence.
• Multivariable analysis confirmed that secondary OVP was associated with a reduced risk of CDI recurrence (OR, 0.10; 95% CI, 0.01-0.86; P = .04).

Conclusions:

• Secondary OVP is effective in reducing the risk of recurrent CDI in pediatric patients with a prior history of the infection.
• This prophylactic strategy appears safe, with no vancomycin-resistant enterococci infections reported in either group.