Long-Duration Oral Vancomycin to Treat Clostridioides difficile in Patients With Inflammatory Bowel Disease Is Associated With a Low Rate of Recurrence

Abstract

OBJECTIVES: Patients with inflammatory bowel disease (IBD) are susceptible to Clostridioides difficile infections (CDIs), suffering from greater morbidity and mortality than the general population. Previous studies have proven the efficacy of oral vancomycin therapy in CDI, but there are no definitive guidelines to treat patients with IBD. We assessed the relationship between the length of vancomycin therapy and rates of CDI recurrence and reinfection in patients with IBD. METHODS: We compared rates of CDI recurrence and reinfection in Crohn's disease and ulcerative colitis (UC) patients receiving long-duration (LD) and short-duration (SD) oral vancomycin therapy, defined as 21–42 days and 10–14 days, respectively. Recurrence and reinfection were defined as positive C. difficile toxin assay by polymerase chain reaction within 8 weeks of the end of antibiotic therapy and after 8 weeks of the end of antibiotic therapy, respectively. The Fisher exact test was used to test for significance, and multivariate logistic regression models were constructed to control for other covariables. RESULTS: One hundred thirty-four patients with IBD (57 ulcerative colitis and 77 Crohn's disease) met inclusion criteria. LD vancomycin had a 1.8% incidence of CDI recurrence, compared with 11.7% in the SD vancomycin group (odds ratio = 0.13, P = 0.043). CDI reinfection rates and time to reinfection were not significantly different (LD 14.0% vs SD 16.9%, P = NS). Multivariate logistic regression models showed that treatment with LD vancomycin had lower odds for recurrence than SD vancomycin (odds ratio = 0.03, P = 0.021). DISCUSSION: LD vancomycin is associated with lower rates of CDI recurrence compared with SD vancomycin therapy. These results will help guide clinical decisions and the development of a prospective trial.

Gastrointestinal Dopamine in Inflammatory Bowel Diseases: A Systematic Review

“…This study further confirms the ability of intestinal microflora to modulate the gastrointestinal dopaminergic system [ 44 ]. Although vancomycin has been an important medication in the treatment of IBD flares associated with Clostridium difficile , as well as dysbiosis, and should also be considered a frontline antibiotic therapy in IBD [ 64 ], its use might be associated with alterations in the gastrointestinal catecholamine turnover and the expansion of colitogenic bacteria (Mucispirillum, Desulfovibrio, and Helicobacteraceae) [ 44 ]. Yet, no comparison was made between TRUC mice treated with antibiotics versus wild-type mice.…”

Management of Clostridioides difficile infection in patients with inflammatory bowel disease

“…In another retrospective study comparing, rates of CDI recurrence and reinfection in IBD patients receiving long (21-42 days) or shortduration (10-14 days) oral vancomycin therapy, demonstrated a 1.8% incidence of CDI recurrence in the long-duration compared to 11.7% in the short-duration treatment group. 49 A retrospective study evaluated fidaxomicin use in 21 IBD patients who had CDI and demonstrated that all patients responded either with symptom improvement or a negative C. difficile test. The rate of recurrent CDI was 19% with a median time to recurrence of 29 days.…”

Management of the Hospitalized Patient with Inflammatory and Stricturing Crohn’s Disease

“…Antibiotic therapy should be reserved for patients with documented infections such as intra-abdominal abscesses or C. difficile. In patients with C. difficile infection in particular, oral vancomycin is considered firstline therapy for 10-14 days, though prolonged duration of therapy may prevent recurrence rates within 8 weeks of antibiotic discontinuation [24,48].…”