Comparative Effectiveness of #Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With #Clostridium difficile Infection
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2601079
Recurrence rates were similar among patients treated with vancomycin and metronidazole. However, the risk of 30-day mortality was significantly reduced among patients who received vancomycin. Our findings may further justify the use of vancomycin as initial therapy for severe CDI.
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2601079
Recurrence rates were similar among patients treated with vancomycin and metronidazole. However, the risk of 30-day mortality was significantly reduced among patients who received vancomycin. Our findings may further justify the use of vancomycin as initial therapy for severe CDI.
Jamanetwork
Comparative Effectiveness of Vancomycin and Metronidazole for C difficile Infection
This propensity-matched cohort study evaluates the risk of recurrence and all-cause 30-day mortality in patients receiving metronidazole or vancomycin for mild to moderate and severe Clostridium difficile infection.
EMA recommends changes to #prescribing information for #vancomycin antibiotics
http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Vancomycin-containing_medicines/human_referral_000399.jsp&mid=WC0b01ac05805c516f
vancomycin can continue to be used for the treatment of serious infections caused by certain bacteria including MRSA (meticillin-resistant Staphylococcus aureus) in patients of all ages. Vancomycin can also be used to prevent bacterial endocarditis (an infection in the heart) in patients undergoing surgery and to treat infections in patients undergoing a procedure called peritoneal dialysis. When taken by mouth, use should be limited to the treatment of Clostridium difficile infections (CDI).
Because the available data do not adequately support the use of vancomycin in the treatment of staphylococcal enterocolitis (inflammation of the gut caused by S. aureus) and its use to clear the gut of bacteria in patients with a weakened immune (defence) system, the CHMP concluded that vancomycin should no longer be used for these indications.
In addition, the Committee reviewed the recommended dosage for vancomycin for the various indications and patient groups, and concluded that the starting dose of vancomycin by infusion should be calculated according to the age and weight of the patient. The updated recommendations are based on data which showed that the previously recommended dose often resulted in less than optimal levels of vancomycin in the blood, reducing the effectiveness of the antibiotic.
http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Vancomycin-containing_medicines/human_referral_000399.jsp&mid=WC0b01ac05805c516f
vancomycin can continue to be used for the treatment of serious infections caused by certain bacteria including MRSA (meticillin-resistant Staphylococcus aureus) in patients of all ages. Vancomycin can also be used to prevent bacterial endocarditis (an infection in the heart) in patients undergoing surgery and to treat infections in patients undergoing a procedure called peritoneal dialysis. When taken by mouth, use should be limited to the treatment of Clostridium difficile infections (CDI).
Because the available data do not adequately support the use of vancomycin in the treatment of staphylococcal enterocolitis (inflammation of the gut caused by S. aureus) and its use to clear the gut of bacteria in patients with a weakened immune (defence) system, the CHMP concluded that vancomycin should no longer be used for these indications.
In addition, the Committee reviewed the recommended dosage for vancomycin for the various indications and patient groups, and concluded that the starting dose of vancomycin by infusion should be calculated according to the age and weight of the patient. The updated recommendations are based on data which showed that the previously recommended dose often resulted in less than optimal levels of vancomycin in the blood, reducing the effectiveness of the antibiotic.
www.ema.europa.eu
European Medicines Agency - Human medicines - Vancomycin-containing medicines
European Union agency responsible for the protection of public and animal health through the scientific evaluation and supervision of medicines.
Peripheral modifications of Ψ[CH2NHTpg4] #vancomycin with added synergistic mechanisms of action provide durable and potent antibiotics
http://m.pnas.org/content/early/2017/05/23/1704125114
In a quest for antibiotics that may display durable clinical lifetimes, analogs of the glycopeptide antibiotics, including vancomycin, have been designed that not only directly overcome the molecular basis of existing vancomycin #resistance but also contain two added peripheral modifications that endow them with two additional independent mechanisms of actions not found in the parent antibiotics. It is shown that such peripherally and binding pocket-modified vancomycin analogs display little propensity for acquired resistance by vancomycin-resistant Enterococci and that both their antimicrobial potency and durability against such challenges follow trends (three > two > one mechanisms of action) that are now predictable.
http://m.pnas.org/content/early/2017/05/23/1704125114
In a quest for antibiotics that may display durable clinical lifetimes, analogs of the glycopeptide antibiotics, including vancomycin, have been designed that not only directly overcome the molecular basis of existing vancomycin #resistance but also contain two added peripheral modifications that endow them with two additional independent mechanisms of actions not found in the parent antibiotics. It is shown that such peripherally and binding pocket-modified vancomycin analogs display little propensity for acquired resistance by vancomycin-resistant Enterococci and that both their antimicrobial potency and durability against such challenges follow trends (three > two > one mechanisms of action) that are now predictable.
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Oral #vancomycin prophylaxis during systemic antibiotic exposure to prevent #Clostridiodes difficile infection relapses
https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/oral-vancomycin-prophylaxis-during-systemic-antibiotic-exposure-to-prevent-clostridiodes-difficile-infection-relapses/B3BCADC21F30A64E21AB7CB433AD0D75
We compared relapse rates in patients who started oral vancomycin concurrently with systemic antibiotics (exposed group) versus those who did not. We assessed for CDI relapse by toxin or nucleic acid testing at 90 days
CDI relapse occurred within 90 days in 19 of 193 exposed patients (9.8%) versus 53 of 567 unexposed patients (9.4%; unadjusted odds ratio OR, 1.06; 95% confidence interval CI, 0.60–1.81; adjusted OR, 0.63; 95% CI, 0.35–1.14). CDI relapses at 90 days were less frequent in exposed patients with only 1 prior episode of CDI (OR, 0.42; 95% CI, 0.19–0.93) but not in those with >1 prior episode (OR, 1.19; 95% CI, 0.42–3.33). Our findings were consistent with a lack of benefit of oral vancomycin when restricting results to toxin-positive relapses and to patients who received vancomycin each antibiotic day.
Conclusions:
Prophylactic oral vancomycin was not consistently associated with reduced risk of CDI relapse among hospitalized patients receiving systemic antibiotics. However, patients with only 1 prior CDI episode may benefit.
Oral #vancomycin prophylaxis during systemic antibiotic exposure to prevent #Clostridiodes difficile infection relapses
https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/oral-vancomycin-prophylaxis-during-systemic-antibiotic-exposure-to-prevent-clostridiodes-difficile-infection-relapses/B3BCADC21F30A64E21AB7CB433AD0D75
We compared relapse rates in patients who started oral vancomycin concurrently with systemic antibiotics (exposed group) versus those who did not. We assessed for CDI relapse by toxin or nucleic acid testing at 90 days
CDI relapse occurred within 90 days in 19 of 193 exposed patients (9.8%) versus 53 of 567 unexposed patients (9.4%; unadjusted odds ratio OR, 1.06; 95% confidence interval CI, 0.60–1.81; adjusted OR, 0.63; 95% CI, 0.35–1.14). CDI relapses at 90 days were less frequent in exposed patients with only 1 prior episode of CDI (OR, 0.42; 95% CI, 0.19–0.93) but not in those with >1 prior episode (OR, 1.19; 95% CI, 0.42–3.33). Our findings were consistent with a lack of benefit of oral vancomycin when restricting results to toxin-positive relapses and to patients who received vancomycin each antibiotic day.
Conclusions:
Prophylactic oral vancomycin was not consistently associated with reduced risk of CDI relapse among hospitalized patients receiving systemic antibiotics. However, patients with only 1 prior CDI episode may benefit.