1490. Vancomycin 125 mg vs. 250 mg for the Treatment of Non-Severe and Severe Clostridium difficile Infections

Abstract

BackgroundInfectious Diseases Society of America (IDSA) guidelines recommend oral vancomycin 125 mg four times daily for 10 to 14 days for both non-severe and severe Clostridium difficile infections (CDI). Although 125 mg achieves sufficient fecal concentrations, doses of 250 mg are still commonly used in practice. There is limited data available comparing vancomycin 125 mg to higher doses. To the best of our knowledge, there are no studies that compare the effectiveness of vancomycin 125 mg vs. 250 mg in the treatment of CDI.MethodsSingle-center, retrospective cohort analysis of oral vancomycin 125 mg vs. 250 mg for the treatment of CDI between June 2018 and February 2019. Diagnosis of CDI involved symptomatic patients with positive Clostridium difficile toxin by either polymerase chain reaction or toxin enzyme immunoassay. We used IDSA guideline criteria of severe and non-severe to evaluate those who received a 10- or 14-day course of oral vancomycin. We excluded patients with concomitant metronidazole or fidaxomicin use, history of CDI in the past 8 weeks, fulminant CDI, or mortality prior to completion of therapy. The primary outcome was resolution of clinically significant diarrhea. Secondary outcomes included duration of loose stools, relapse of CDI within 30 days of diagnosis, and 30-day all-cause mortality.ResultsA total of 93 patients were included in the study, with 71 patients (76.3%) in the 125 mg group and 22 patients (23.7%) in the 250 mg group. Both groups were well matched with no significant differences at baseline or during treatment. Results showed no statistical difference in clinical resolution between the 125 mg and 250 mg groups, with 70 patients (98.6%) and 22 patients (100%) achieving clinical resolution, respectively (P = 1.00). Secondary outcomes revealed no statistical difference in duration of symptoms, relapse, or 30-day all-cause mortality.ConclusionThere was no difference in clinical resolution of CDI between the vancomycin 125 mg and 250 mg groups. Furthermore, the dose of vancomycin did not have a significant effect on duration of symptoms, relapse, or 30-day all-cause mortality. Using the lower, guideline-recommended dose of vancomycin could potentially reduce patient exposure and provide cost-savings benefits without sacrificing efficacy. Disclosures All authors: No reported disclosures.