Background. Oral vancomycin was the first agent approved for the treatment of Clostridium difficile infection (CDI). Vancomycin achieves high concentrations in the feces following oral administration and is typically formulated as a capsule. Because vancomycin capsules are significantly expensive, hospital pharmacies extemporaneously compound an oral solution using the generic intravenous formulation of vancomycin. Oral vancomycin solution has been shown to display comparable dose-dependent fecal concentrations with therapeutic levels over 100 times the minimum inhibitory concentration for C. difficile. The purpose of this study is to evaluate clinical outcomes between oral vancomycin capsules and oral vancomycin compounded solution for the treatment of CDI.
Methods. A retrospective review was conducted on adult inpatients who received oral vancomycin capsules or solution for ≥ 48 hours for the treatment of severe or severe complicated CDI from 2008 to 2013. Data was collected and analyzed to compare clinical cure and failure rates, CDI recurrence rates, length of hospital stay, and incidence of complications related to CDI between oral vancomycin capsules and solution.
Results. One hundred two patients received oral vancomycin for the treatment of CDI, but 34 patients were evaluated for CDI clinical outcomes. Fifty percent of the patients were male with a median age of 62 years (range 25 – 97). CDI severity was similar between the oral capsule and solution groups with 47% of patients with severe CDI and 35% of patients with severe complicated CDI (p = 0.7908). Overall, patients treated with oral vancomycin capsules and solution were found to have clinical cure rates of 74% (14/19) and 67% (10/15), respectively (OR 1.40 (0.32-6.16), p = 0.7176). Three patients treated with oral vancomycin solution had CDI recurrences compared to zero patients in the oral capsule group (OR 0.08 (0-1.78), p = 0.0667).
Conclusion. Severe CDI treated with oral vancomycin solution appears to be associated with similar clinical outcomes when treated with oral vancomycin capsules. However, larger, prospective studies are warranted to further characterize this relationship.
Disclosures. All authors: No reported disclosures.