Intracolonic Vancomycin Adds to C. difficile Therapy

LAS VEGAS — Intracolonic administration of vancomycin, given by retention enemas, was an effective adjunct to conventional oral and intravenous antibiotic therapy in patients with severe, fulminant Clostridium difficile colitis.

In a series of 47 consecutive patients treated at a U.S. center from January 2007 to October 2009, 37 (79%) survived and 33 (70%) had complete resolution of the colitis, Dr. Peter K. Kim and his associates reported in a poster at the annual meeting of the Surgical Infection Society.

“Intracolonic vancomycin may have an important role in the management of severe C. difficile colitis as an adjunct to oral vancomycin and intravenous metronidazole. It may decrease the need for colectomy and improve mortality when used in addition to standard therapy,” Dr. Kim and his associates said in their poster.

The 79% survival rate was better than the rates of about 25%–50% in similar patients with severe C. difficile colitis before the intracolonic approach was adopted in 2007, Dr. Kim said in an interview.

No patient receiving intracolonic vancomycin had an adverse event linked to the treatment, said Dr. Kim, a surgeon at Jacobi Medical Center and Albert Einstein College of Medicine, both in New York.

Patients who responded to intracolonic vancomycin had improvement within 48 hours of starting treatment. Responders generally did not require surgery, which is advantageous because patients who need surgery often subsequently die.

The 47 patients had a mean age of 65, and 62% were women. Their mean APACHE (Acute Physiology and Chronic Health Evaluation) II score was 23, with a range of 14–47. Most were nursing home residents prior to hospitalization.

Patients received a conventional antibiotic regimen for C. difficile of oral vancomycin and intravenous metronidazole, as well as the adjunctive intracolonic vancomycin (1 g delivered in 500 cc normal saline, given an enema that patients held for 15 minutes, administered every 6 hours). Patients received intracolonic vancomycin for an average of 6.6 days.

The 33 patients with complete resolution had total elimination of their colitis by the time the intracolonic and conventional regimens had been completed. None of these 33 patients required surgery; 30 survived and 3 died.

The 14 patients with incomplete resolution had either no response or a partial response, and continued to show features of colitis such as persistent diarrhea; abdominal distention, tenderness, or pain; or persistent pancolitis on CT. Nine of the 14 nonresponders underwent colectomy. Seven of the surgery patients survived, and two died. All five patients without complete resolution who did not have surgery died.

The researchers based the dosage of vancomycin on prior reports. A few other U.S. surgical programs currently also use this treatment, they said.

Disclosures: Dr. Kim and his associates had no relevant disclosures.

Adding intracolonic vancomycin increased the survival rate to 79% vs. 25%–50% with standard therapy alone.

Source CDC/Dr. Gilda Jones

LAS VEGAS — Intracolonic administration of vancomycin, given by retention enemas, was an effective adjunct to conventional oral and intravenous antibiotic therapy in patients with severe, fulminant Clostridium difficile colitis.

In a series of 47 consecutive patients treated at a U.S. center from January 2007 to October 2009, 37 (79%) survived and 33 (70%) had complete resolution of the colitis, Dr. Peter K. Kim and his associates reported in a poster at the annual meeting of the Surgical Infection Society.

“Intracolonic vancomycin may have an important role in the management of severe C. difficile colitis as an adjunct to oral vancomycin and intravenous metronidazole. It may decrease the need for colectomy and improve mortality when used in addition to standard therapy,” Dr. Kim and his associates said in their poster.

The 79% survival rate was better than the rates of about 25%–50% in similar patients with severe C. difficile colitis before the intracolonic approach was adopted in 2007, Dr. Kim said in an interview.

No patient receiving intracolonic vancomycin had an adverse event linked to the treatment, said Dr. Kim, a surgeon at Jacobi Medical Center and Albert Einstein College of Medicine, both in New York.

Patients who responded to intracolonic vancomycin had improvement within 48 hours of starting treatment. Responders generally did not require surgery, which is advantageous because patients who need surgery often subsequently die.

The 47 patients had a mean age of 65, and 62% were women. Their mean APACHE (Acute Physiology and Chronic Health Evaluation) II score was 23, with a range of 14–47. Most were nursing home residents prior to hospitalization.

Patients received a conventional antibiotic regimen for C. difficile of oral vancomycin and intravenous metronidazole, as well as the adjunctive intracolonic vancomycin (1 g delivered in 500 cc normal saline, given an enema that patients held for 15 minutes, administered every 6 hours). Patients received intracolonic vancomycin for an average of 6.6 days.

The 33 patients with complete resolution had total elimination of their colitis by the time the intracolonic and conventional regimens had been completed. None of these 33 patients required surgery; 30 survived and 3 died.

The 14 patients with incomplete resolution had either no response or a partial response, and continued to show features of colitis such as persistent diarrhea; abdominal distention, tenderness, or pain; or persistent pancolitis on CT. Nine of the 14 nonresponders underwent colectomy. Seven of the surgery patients survived, and two died. All five patients without complete resolution who did not have surgery died.

The researchers based the dosage of vancomycin on prior reports. A few other U.S. surgical programs currently also use this treatment, they said.

Disclosures: Dr. Kim and his associates had no relevant disclosures.

Adding intracolonic vancomycin increased the survival rate to 79% vs. 25%–50% with standard therapy alone.

Source CDC/Dr. Gilda Jones

LAS VEGAS — Intracolonic administration of vancomycin, given by retention enemas, was an effective adjunct to conventional oral and intravenous antibiotic therapy in patients with severe, fulminant Clostridium difficile colitis.

In a series of 47 consecutive patients treated at a U.S. center from January 2007 to October 2009, 37 (79%) survived and 33 (70%) had complete resolution of the colitis, Dr. Peter K. Kim and his associates reported in a poster at the annual meeting of the Surgical Infection Society.

“Intracolonic vancomycin may have an important role in the management of severe C. difficile colitis as an adjunct to oral vancomycin and intravenous metronidazole. It may decrease the need for colectomy and improve mortality when used in addition to standard therapy,” Dr. Kim and his associates said in their poster.

The 79% survival rate was better than the rates of about 25%–50% in similar patients with severe C. difficile colitis before the intracolonic approach was adopted in 2007, Dr. Kim said in an interview.

No patient receiving intracolonic vancomycin had an adverse event linked to the treatment, said Dr. Kim, a surgeon at Jacobi Medical Center and Albert Einstein College of Medicine, both in New York.

Patients who responded to intracolonic vancomycin had improvement within 48 hours of starting treatment. Responders generally did not require surgery, which is advantageous because patients who need surgery often subsequently die.

The 47 patients had a mean age of 65, and 62% were women. Their mean APACHE (Acute Physiology and Chronic Health Evaluation) II score was 23, with a range of 14–47. Most were nursing home residents prior to hospitalization.

Patients received a conventional antibiotic regimen for C. difficile of oral vancomycin and intravenous metronidazole, as well as the adjunctive intracolonic vancomycin (1 g delivered in 500 cc normal saline, given an enema that patients held for 15 minutes, administered every 6 hours). Patients received intracolonic vancomycin for an average of 6.6 days.

The 33 patients with complete resolution had total elimination of their colitis by the time the intracolonic and conventional regimens had been completed. None of these 33 patients required surgery; 30 survived and 3 died.

The 14 patients with incomplete resolution had either no response or a partial response, and continued to show features of colitis such as persistent diarrhea; abdominal distention, tenderness, or pain; or persistent pancolitis on CT. Nine of the 14 nonresponders underwent colectomy. Seven of the surgery patients survived, and two died. All five patients without complete resolution who did not have surgery died.

The researchers based the dosage of vancomycin on prior reports. A few other U.S. surgical programs currently also use this treatment, they said.

Disclosures: Dr. Kim and his associates had no relevant disclosures.

Adding intracolonic vancomycin increased the survival rate to 79% vs. 25%–50% with standard therapy alone.

Source CDC/Dr. Gilda Jones