Posted: February 19th, 2023

What is the role of oral vancomycin in Clostridioides difficile infection prophylaxis?

What is the role of oral vancomycin in Clostridioides difficile infection prophylaxis? Background:

Paragraph 1: Background information about disease state topic and medication (including Pharmacologic category, brand name, route of administration, dosing, renal or hepatic adjustments, summary of warnings/precautions, etc).

Paragraph 2: Cite and discuss the specific guideline recommendations and level of evidence (when available)

You may want to start by saying something like According to the 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, in patients with…..(recommendation). Please insert the guideline that you used.
Guidelines can include published recommendations from national organizations, such as the Centers for Disease Control (CDC)
Provided that you gave enough background about the disease state and medications before this point you may want to discuss why this is. Was the reason this medication was recommended because of its effect on morbidity and mortality, cardiovascular disease, potential side effects, cost, etc? This information is typically found and elaborated on within the guidelines, textbooks, and/or UptoDate. Also discuss the level of evidence behind the recommendation.
Paragraph 3: Primary literature to support the guideline recommendation

Summarize the primary article(s) that was used to support the recommendation. This would include including the objective of the study, patient population studied, what were the two groups (control and intervention group), methods and type of study, primary outcome, results and conclusion of the study. This can mostly be pulled from the abstract of the study. However, I do recommend reading the entire article as parts of the introduction, discussion and conclusion may provide you with more information to include into other sections in the drug information response.
Recommendation/Conclusion:

Paragraph 4: Conclusion (Overall Recommendation Summary)

Provide answer to drug information question that is adequately supported by literature
If drug information request requires a treatment recommendation, be sure to include a specific therapeutic recommendation (medication, dose, route, frequency, duration, monitoring, etc.)

References:

Cite in AMA format numerical order with superscripts in the answer
Use multiple references to answer drug information question – including treatment guidelines, tertiary literature (i.e., treatment guidelines), primary literature, etc.
At least one reference should be primary literature
MUST BE ONE PAGE SINGLE SPACED. CAN NOT EXCEED 1 PAGE. (not including reference page)
Must use : https://journals.lww.com/ajg/fulltext/2021/06000/a… as one of the references

Clostridioides difficile infection (CDI) is a common hospital-acquired infection associated with significant morbidity and mortality. Oral vancomycin, a glycopeptide antibiotic, is commonly used for the treatment of CDI. However, the role of oral vancomycin in CDI prophylaxis is not well established.

According to the 2021 American College of Gastroenterology (ACG) clinical guideline for the management of CDI, the use of oral vancomycin as prophylaxis is not recommended in the general hospitalized population.^1 The guideline suggests that oral vancomycin prophylaxis can be considered in certain high-risk populations, such as patients undergoing hematopoietic stem cell transplantation or solid organ transplantation.

The ACG guideline is based on a systematic review of the available evidence on the use of CDI prophylaxis.^1 The review identified three randomized controlled trials (RCTs) that evaluated the use of oral vancomycin for CDI prophylaxis.^1 Two of the studies were in high-risk populations, including allogeneic hematopoietic stem cell transplant recipients and liver transplant recipients, and both showed a significant reduction in the incidence of CDI with oral vancomycin prophylaxis compared to placebo or no prophylaxis.^1 However, the third study in a general hospitalized population did not show a significant reduction in CDI incidence with oral vancomycin prophylaxis.^1

In conclusion, the use of oral vancomycin for CDI prophylaxis is not recommended in the general hospitalized population, but can be considered in certain high-risk populations, according to the 2021 ACG guideline. The evidence supporting the use of oral vancomycin for CDI prophylaxis is limited and primarily based on studies in high-risk populations.

References:

McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridioides difficile Infection in Adults and Children: 2021 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2021;ciab1094. doi:10.1093/cid/ciab1094.

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