A Propensity-Matched Analysis Between Standard Versus Tapered Oral Vancomycin Courses for the Management of Recurrent Clostridium difficile Infection

Abstract

BackgroundThis study was conducted to compare clinical outcomes of oral vancomycin courses without taper versus oral vancomycin courses with taper for treatment of recurrent Clostridium difficile infection (CDI).MethodsThis investigation was a multicenter, retrospective, propensity score-matched analysis study using a Veterans Health Administration national clinical administrative database. Adult patients who were treated for recurrent CDI from any Veterans Affairs Medical Center between June 1, 2011 and October 31, 2016 were included if they were treated with oral vancomycin with or without a tapering regimen. The 2 groups were matched by next-nearest approach from a propensity score formula derived from independent variables associated with the selection of a taper regimen.ResultsPropensity score matching resulted in 2 well-matched groups consisting of 226 episodes of patients treated with a vancomycin taper regimen and 678 episodes treated by vancomycin regimen without taper. No difference was found for the primary outcome of 180-day recurrence (59 of 226 [26.1%] for taper regimens versus 161 of 678 [23.8%], P = .48). A secondary outcome of 90-day all-cause mortality met statistical significance, favoring a taper regimen (5.31% vs 9.29%, P = .049); however, secondary outcomes of 90-day recurrence and 180-day all-cause mortality were not different.ConclusionsVancomycin taper regimens did not provide benefit over vancomycin regimens without taper in preventing additional CDI recurrence in patients with first or second recurrent episodes in this propensity score-matched analysis.

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“…There is also some evidence that pulsed/tapered dosing of vancomycin and fidaxomicin (including pulsed fidaxomicin65) results in fewer recurrences than with standard dosing of these agents66 67 (although this finding has not been replicated in all studies68). Pre-planned subgroup analysis of patients with severe CDI in a randomised trial demonstrated a significantly lower recurrence rate when treated with fidaxomicin (13.0%, n=12/92) than when treated with vancomycin (26.6%, n=29/209)63; this finding was replicated in another RCT, with 8.3% (n=4/48) and 32.6% (n=14/43) experiencing a recurrence, respectively 69.…”

Fidaxomicin versus oral vancomycin for severe Clostridium difficile infection: a retrospective cohort study

“…The study was approved by the University of Oklahoma Institutional Review Board, Oklahoma City VA Health Care System Research and Development Committee, and the Veterans Health Administration (VHA) Corporation Data Warehouse. Methods used were similar to our previous project on vancomycin taper for recurrent CDI, modified to include initial episodes and only severe episodes [7].…”

Economic evaluation of Faecal microbiota transplantation compared to antibiotics for the treatment of recurrent Clostridioides difficile infection

“…Although this is less evident with FMT [25]. Additionally, the model assumes that vancomycin TP is more effective than vancomycin, however, this assumption is potentially questionable as evidence suggest that the vancomycin taper regimen was not superior to standard vancomycin treatment [43]. Although given the result of the model this assumption bears no impact on the results.…”