Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of <i>Clostridioides difficile</i> Infection: A Systematic Review and Meta-Analysis

• Main Authors: Chia-Yu Chiu (Author), Amara Sarwal (Author), Addi Feinstein (Author), Karen Hennessey (Author)
• Format: Book
• Published: MDPI AG, 2019-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2079-6382; 10.3390/antibiotics8040173
• Keywords: <i>clostridioides difficile</i>; <i>clostridium difficile</i>; vancomycin; fecal vancomycin concentration; escalate dosage; Therapeutics. Pharmacology; RM1-950
• Source: Antibiotics, Vol 8, Iss 4, p 173 (2019)

Background: Oral vancomycin is a first line treatment for an initial episode of <i>Clostridioides difficile</i> infection. However, the comparative efficacy of different dosing regimens is lacking evidence in the current literature. Methods: We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. from inception to May 2019. Only articles published in English are reviewed. This meta-analysis compares the effects of low dose oral vancomycin (<2 g per day) versus high dose vancomycin (2 g per day) for treatment of initial <i>Clostridioides difficile</i> infection. Results: One randomized controlled trial and two retrospective cohort studies are included. A total of 137 patients are identified, 53 of which were treated with low dose oral vancomycin (39%) and 84 with high dose oral vancomycin (61%). There is no significant reduction in recurrence rates with high dose vancomycin compared to low dose vancomycin for treating initial episodes of non-fulminant <i>Clostridioides difficile</i> infection ((odds ratio (OR) 2.058, 95%, confidence interval (CI): 0.653 to 6.489). <i>Conclusions</i>: Based on limited data in the literature, low dose vancomycin is no different than high dose vancomycin for treatment of an initial episode of <i>Clostridioides difficile</i> infection in terms of recurrence rate. Additional large clinical trials comparing the different dosages of vancomycin in initial <i>Clostridioides difficile</i> infection are warranted.