Outcomes from Rectal Vancomycin Therapy in Patients With Clostridium difficile Infection

Saffouri, George; Khanna, Sahil; Estes, Lynn L.; Pardi, Darrell S.

doi:10.1038/ajg.2014.80

Cited by 10 publications

(9 citation statements)

References 5 publications

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“…Reports of high serum vancomycin levels with 500 mg four times day dosing have also been noted in patients . Intravenous vancomycin therapy is not effective in CDI, however, colonic administration through an enema may be effective as an adjunctive therapy (uncertain dosing) if oral therapy is unable to be tolerated (500 mg in 100 mL normal saline, rectally 6 hourly) …”

Section: What Antibiotics Should Be Used For Treatment Of An Initial mentioning

confidence: 99%

“…[70][71][72] Intravenous vancomycin therapy is not effective in CDI, however, colonic administration through an enema may be effective as an adjunctive therapy (uncertain dosing) if oral therapy is unable to be tolerated (500 mg in 100 mL normal saline, rectally 6 hourly). 4,[73][74][75] Recommendations 1. Oral metronidazole is recommended for initial episode CDI without clinical features of severe disease at 400 mg three times daily for 10 days.…”

Section: Dosing and Administrationmentioning

confidence: 99%

See 1 more Smart Citation

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

Trubiano

Cheng

Korman

et al. 2016

Internal Medicine Journal

128

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The incidence of Clostridium difficile infection (CDI) continues to rise, whilst treatment remains problematic due to recurrent, refractory and potentially severe nature of disease. The treatment of C. difficile is a challenge for community and hospital-based clinicians. With the advent of an expanding therapeutic arsenal against C. difficile since the last published Australasian guidelines, an update on CDI treatment recommendations for Australasian clinicians was required. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children.

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Section: What Antibiotics Should Be Used For Treatment Of An Initial mentioning

confidence: 99%

Section: Dosing and Administrationmentioning

confidence: 99%

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

Trubiano

Cheng

Korman

et al. 2016

Internal Medicine Journal

128

View full text Add to dashboard Cite

show abstract

“…We present a retrospective study of 127 patients describing the utility of treating severe CDI using intracolonic vancomycin. To our knowledge this is the second largest case series published to date [ 6 , 9 – 11 ] (Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

The efficacy of intracolonic vancomycin for severe Clostridium difficile colitis: a case series

et al. 2016

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BackgroundClostridium difficile infection (CDI) unresponsive to the standard treatments of metronidazole and oral vancomycin requires aggressive medical management and possible surgical intervention including colectomy. Intracolonic vancomycin therapy has been reported to be particularly promising in the setting of severe CDI in the presence of ileus. This is a descriptive case series exploring the effect of adjunctive intracolonic vancomycin therapy on the morbidity and mortality in patients with moderate to severe CDI.MethodsA retrospective chart review was conducted on 696 patients with CDI seen at a single institution. Each patient was assigned a severity score and 127 patients with moderate to severe CDI were identified. We describe the clinical presentation, risk factors and hospital course comparing those that received adjunctive intracolonic vancomycin to those that only received standard therapy.ResultsThe group that received adjunctive intracolonic vancomycin had higher rates of toxic megacolon, intensive care unit (ICU) admission, and colectomy, and yet maintained a similar mortality rate as the group that received only standard treatment.ConclusionThe intracolonic vancomycin group experienced more complications but showed a similar mortality rate to the standard therapy group, suggesting that intracolonic vancomycin may impart a protective effect. This study adds further evidence for the need of a randomized controlled study using intracolonic vancomycin as adjunctive therapy in patients presenting with severe CDI.

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“…In a report from the Mayo Clinic of 17 patients with severe CDI treated with vancomycin enemas, variable vancomycin doses (most commonly 500 mg) and saline volumes (9 of 17 had 500-1,000 mL) were used [16]. No information was provided on whether there were retention enemas.…”

Section: Evidence For the Efficacy Of Vancomycin Enema For CDImentioning

confidence: 99%

Vancomycin Enema in the Treatment ofClostridium difficileInfection

Fawley

Napolitano

2019

Surgical Infections

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Background: Current guidelines for the treatment of Clostridium difficile infections (CDIs) recommend vancomycin enemas for patients with adynamic ileus. There is significant variability in guideline recommendations for vancomycin dose and enema volume and whether a retention enema should be used. The most recent (2017) guidelines from the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America recommend rectal instillation of 500 mg of vancomycin in 100 mL of physiologic saline every 6 hours as a retention enema. Methods: Published studies regarding vancomycin enema use in CDI (1990-present) were reviewed to compare drug dose, volume, and whether a retention enema was used in order to determine the efficacy and make recommendations for optimal dosing. Results: Case series with higher vancomycin dose, higher enema volume, and use of retention enema demonstrated greater efficacy. Use of smaller volumes and lower doses (100 mL; 125-250 mg q 6 hours) demonstrated no efficacy of intracolonic vancomycin. Conclusion: We recommend revision of the current CDI guideline recommendations for patients with adynamic ileus to the following: Vancomycin per rectum (500 mg in a volume of 500 mL q 6 hours) by retention enema (18F Foley catheter with 30-cc balloon inserted into the rectum, balloon inflated, solution instilled, and catheter clamped for 60 minutes) for optimal efficacy.

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Outcomes from Rectal Vancomycin Therapy in Patients With Clostridium difficile Infection

Cited by 10 publications

References 5 publications

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

The efficacy of intracolonic vancomycin for severe Clostridium difficile colitis: a case series

Vancomycin Enema in the Treatment ofClostridium difficileInfection

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