Oral vancomycin is used as a treatment for Clostrioides difficile infection (CDI), and adult studies suggest that vancomycin can be used as a preventative therapy to stop recurrence of CDI in patients receiving antibiotics for other reasons. However, no relevant data exists in children, and the authors of this study looked at the effectiveness of this intervention in children at a single academic health system.
This retrospective study occurred over 6 years and included all children with CDI diagnosed by polymerase chain reaction. Patients were identified who had a prior CDI, had a subsequent outpatient or inpatient encounter, and then required intravenous antibiotic usage during the encounter. This group was then divided into patients who did or did not receive oral vancomycin prophylaxis. Patient demographics were obtained on all patients including the identification of NAP1 (North American pulsed-field gel electrophoresis type 1) strains, use of acid suppression medication, and use of probiotics. Oral vancomycin prophylaxis was defined as dosing of 10 mg / kg every 12 hours during antibiotic administration and for 5 days afterwards.
A total of 148 patients were initially identified; however, the final study patient number after utilizing exclusion criteria consisted of 74 patients (30 receiving oral vancomycin prophylaxis; 44 not receiving oral vancomycin prophylaxis). Patients were statistically similar regarding demographics and comorbidities although more males received oral vancomycin prophylaxis (not significant). Most patients had a history of malignancy or immune suppression. There was no difference between groups in regard to acid suppression use or probiotic use. Hospital length of stay was longer in patients who received oral vancomycin prophylaxis. Most patients had only one prior CDI, and most patients had received antibiotics within 3 months of CDI. Oral vancomycin prophylaxis was more common in patients who had received fluoroquinolones and carbapenems. Oral vancomycin prophylaxis also was significantly more common in patients receiving 2 or more classes of antibiotics and receiving a longer duration of antibiotics. Patients who did not receive oral vancomycin prophylaxis were statistically more likely to have CDI recurrence. No vancomycinresistant enterococci infection occurred in any patient within 8 weeks of vancomycin exposure. Univariate and multivariate analysis demonstrated that receiving oral vancomycin prophylaxis was the only significant factor associated with a reduced risk of CDI.
Oral vancomycin prophylaxis shows the potential of reducing CDI in at-risk pediatric patients with prior CDI. This is a retrospective study, and prospective data is needed to determine optimal timing and duration of oral vancomycin use. Additionally, the risk of vancomycin resistant enterococci infection still remains a concern in such patients.
Bao H, Lighter J, Dubrovskaya Y, Merchan C, Siegfried J, Papadopoulos J, ShinPung J. Oral vancomycin as secondary prophylaxis for Clostrioides difficile infection. Pediatrics 2021; 148: e2020031807.