1020. Comparison of High Dose vs. Low Dose Vancomycin Regimens for Treatment of Clostridium difficile Infection
Session: Poster Abstract Session: Enteric Infection
Friday, October 9, 2015
Room: Poster Hall
  • High dose vs. low dose vancomycin in CDI-IDWeek Poster.pdf (270.2 kB)
  • Background: Clostridium difficileinfection (CDI) is an increasingly prevalent nosocomial infection.  Current guidelines recommend oral (PO) vancomycin 125 mg Q6H for severe CDI and 500 mg Q6H for severe-complicated CDI.  Despite these recommendations, vancomycin doses of 125mg, 250mg, and 500mg are used in clinical practice in patients with various levels of severity.  However, there is little evidence comparing these doses with regards to clinical outcomes.  The objective of this study is to evaluate whether vancomycin dose affects clinical cure rates in patients with CDI.

    Methods: This was a retrospective study evaluating low dose (125 mg) vs. high dose (250/500 mg) PO vancomycin for the treatment of CDI between January 1, 2011 and September 1, 2014.  Included subjects had a first CDI episode and were treated with PO vancomycin.  Subjects were excluded if they were <18 years of age, had a diagnosis of CDI at an outside hospital, received metronidazole for >6 doses or >48 hours before starting PO vancomycin, or were diagnosed with CDI ≤7 days after diagnosis of another systemic infection (excluding urinary tract or skin and soft tissue infections).  The primary outcome was clinical outcome, defined as complete or partial cure at end of treatment or hospital discharge, and evaluated by an equivalence test.  Secondary outcomes included 90-day recurrence-readmission rate, 30-day all-cause mortality, and time to resolution of diarrhea (TTROD).

    Results: 111 subjects were enrolled in the study, with 78 (70.3%) in the low dose group and 33 (29.7%) in the high dose group.  There was no significant difference between low and high dose PO vancomycin with respect to complete or partial cure (70.5% vs. 72.7%), and equivalence was demonstrated (p = 0.03).  Logistic regression identified baseline albumin levels and no ICU admission were associated with complete or partial cure.  Female gender was negatively associated with complete or partial cure.  Secondary outcomes of 90-day recurrence-readmission (15.4% vs. 15.2%, p=0.98), 30-day all-cause mortality (16.7% vs. 21.2%, p=0.57), and TTROD (4 days vs. 5 days, p=0.32) were not significantly different between the low and high dose groups, respectively.

    Conclusion: Vancomycin dose was not found to have an impact on clinical cure rates of patients with an initial episode of CDI.

    Benjamin Ereshefsky, PharmD1, Xing Jin, PharmD1, Lucia Rose, PharmD2, Laura Pontiggia, Ph.D.1 and Dana Byrne, MD2, (1)University of the Sciences, Philadelphia, PA, (2)Cooper University Hospital, Camden, NJ


    B. Ereshefsky, None

    X. Jin, None

    L. Rose, None

    L. Pontiggia, None

    D. Byrne, None

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