1408. Adherence and Recurrence Rates of C. difficile Infection After a 6-Week Tapering Regimen of Oral Vancomycin Solution
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 1408_IDWPOSTER .pdf (447.5 kB)
  • Background: Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea with high recurrence rates.  Vancomycin, administered orally, is an effective treatment. Based on results from a single-center study in 2009 (Lieu D et al, Abs, 5th Dec'l Int’l Conf. on Health-care Associated Infections, March 2010) a standardized 6-week tapering regimen of oral vancomycin solution (four times daily for 2 weeks, then twice daily for 2 weeks, then once daily for 2 weeks) was adopted in 2011 as the standard of care for both initial & recurrent cases of CDI in an effort to decrease CDI relapse rates.  The oral solution is more cost-effective than the oral capsules and is assigned an expiration date of 14 days after compounding.  Since this regimen involves known barriers to medication adherence, this study was conducted to assess the rates of complete adherence and CDI relapse.

    Methods:

    Retrospective analysis of pharmacy fill records & patient charts was performed.  Date range: January 1st, 2011 through September 30th, 2012.  Inclusion: Positive C. difficile toxin test, ≥18 years old, and prescribed the 6-week regimen.  Exclusion: early discontinuation of the taper by physician, use of vancomycin capsules, non-Kaiser Permanente (KP) member, and prescription filled at a non-KP pharmacy.

    Results: Primary Outcome: Of 105 patients, 49 (47%) patients were adherent.  86 of 105 patients (82%) received at least 4 weeks of oral vancomycin. Secondary Outcomes: Rates of 90-day CDI recurrence, hospital admission due to CDI, ED visits due to CDI, and all-cause mortality were not significantly different between patients who were adherent & patients who were non-adherent.  However, the 90-day CDI recurrence rate among all groups was ~12%, less than the 20% reported in the literature.

    Conclusion:

    There is a high rate of non-adherence to the 6-week regimen, but the majority of patients completed at least 4 weeks of treatment.  The effective duration for the taper may be shorter than 6 weeks, considering >80% of patients received at least 4 weeks of oral vancomycin and the overall CDI recurrence rate in this study was ~12% vs. 20%, as reported in literature.  Further studies will be needed to assess the optimal duration of effective therapy.

    Susan Jacobson, MD1, Han Wang, PharmD2, Kelvin Chan, PharmD2 and Tania Chopra, PharmD2, (1)Infectious Disease, Kaiser Permanente, Fremont, CA, (2)Pharmacy, Kaiser Permanente, Hayward, CA

    Disclosures:

    S. Jacobson, None

    H. Wang, None

    K. Chan, None

    T. Chopra, None

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