426. Oral vancomycin 6-week taper regimen, as treatment for both initial and recurrent disease, reduces relapse of Clostridium difficile infection (CDI)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: CDI is a severe health-care associated infection. Relapse rates of > 20% have been reported when metronidazole or vancomycin is discontinued. Observational studies suggest prolonged, tapering, and pulsed-dosed regimens of vancomycin reduce relapse. Prolonged regimens as initial therapy have not been previously studied. We initiated vancomycin 6-week taper for CDI in all patients (including first CDI diagnosis) with any of these risk factors: ≥ 60 years, co-morbidities, and any previous history of CDI.
Objective: Compare vancomycin 6-week taper (V6T) to metronidazole (MET) and to short course (≤ 14 days) vancomycin (SCV) in relapse reduction of CDI, as therapy for initial and recurrent disease.
Methods: We studied all patients in our service area with positive C. difficile toxin (CDT), 7/1 - 9/30/08 as baseline period, 10/1 - 12/31/08 as study period. The primary objective was number of relapses. Relapse was defined as recurrent diarrhea with positive CDT within 3 months of treatment course.
Results:

  1. 191 patients had positive CDT during baseline period, 157 during study period. Both groups were similar in age, gender, antibiotic exposure, acid suppression, previous hospitalizations, and SNF residence.
  2. In the baseline period, 82 patients were treated with MET, 74 with SCV, and 7 with V6T as initial therapy. 24 patients with recurrent disease were treated with V6T. Relapse was seen in 17/82 (20.7%) treated with MET, 12/74 (16.2%) treated with SCV, and 0/7 (0%) treated with V6T as initial therapy. 2 of 24 (8.3%) with recurrent disease treated with V6T relapsed.
  3. In the study period, 27 patients were treated with MET, 27 with SCV, and 73 with V6T as initial therapy. 28 patients with recurrent disease were treated with V6T. Relapse was seen in 5/27 (18.5%) treated with MET, 5/27 (18.5%) treated with SCV, and 6/73 (8.2%) treated with V6T as initial therapy. 2/28 (7.1%) with recurrent disease treated with V6T relapsed.

Conclusion: Oral vancomycin 6-week taper is more effective than metronidazole and short course vancomycin as treatment for both initial and recurrent Clostridium difficile infection (CDI).
Vi Le, PharmD1, Corinne Lieu, BS1, Dale Lieu, MD2, Anne Nguyen, PharmD1, Leia Skol, PharmD1 and  D. Lieu, None..
L. Skol, None..
C. Lieu, None..
A. Nguyen, None..
V. Le, None., (1)Kaiser Permanente, San Diego, CA, (2)Kaiser Permanente Medical Care Program, San Diego, CA