Vancomycin Oral Solution

 

vancomycin oral solution web Edge Pharma produces unit dose oral vancomycin solution for use in hospitals. Because it is imperative for all acute care facilities to keep a stock of oral vancomycin on hand, our prefilled, unit dose oral syringes provide an excellent solution. Designed specifically for oral administration, this product is available in a convenient dosage of 125mg.

Our raspberry marshmallow flavor masks the inherent bitterness of antibiotics in order to make it palatable to patients.

Vancomycin Oral Solution (PF)

2.5mL single dose syringe for oral use only

  • Vancomycin HCl 125mg/2.5mL
  • Refrigerated storage

 

References

Johnson, S. PharmD, Brown, S., Priest, D. M.D., MPH, Oxford University Press, The Effectiveness of Oral Vancomycin for Prevention of Healthcare Facility-Onset Clostridiodes Difficile in Targeted Patients During Systemic Antibiotic Exposure, https://pubmed.ncbi.nlm.nih.gov

“Oral vancomycin prophylaxis appears to protect against Healthcare Facility-Onset Clostridiodes difficile infection in targeted patients during systemic antibiotic exposure.”

 

Literature Review

 

Oral Vancomycin Prophylaxis Prevents C. diff, Study Finds

Control of Clostridium difficile infection (C. diff) is a serious and ongoing challenge for healthcare facilities in the U.S. Close to half a million Americans are infected with C. diff each year, and of those 29,000 will die within one month of being diagnosed. The CDC further reports that C. diff results in $4.8 billion each year in excess healthcare costs for acute facilities.

At a large urban hospital in Chicago, researchers developed an assessment tool to predict patients’ risk of developing C. diff. Patients were assessed points for a variety of risk factors, such as a history of C. diff, age over 80, and a hospital stay of more than seven days.  Patients receiving a risk score of 13 or over were considered high risk.

During an intervention period, patients with the risk score of 13 or over were administered oral vancomycin 125mg twice daily. Of the patients on this regimen, 8% developed C. diff. Before the intervention period, high risk patients had not been given the oral vancomycin prophylactically. Of these patients, 87.8% developed C. diff. 

Researchers at a large urban hospital set out to find if oral vancomycin, administered to patients considered high risk, prevented C. diff infections. The researchers used an assessment tool to determine risk for patients. The tool assigned points for various risk factors, as follows (1)

 

History of C. diff within one year               13 points

History of C. diff greater than one year   8 points

High-risk antibiotics use                                5 points

Hospital length of stay over 7 days           3 points

Immunocompromised                                   3 points

Age over 65                                                         2 points

Long-term care facility resident                 1 point

Hypoalbuminemia                                           1 point

Age over 80 years                                            1 point

PP1/H2RA use in hospital                              1 point

Hospitalized within 90 days                         1 point

 

From January 2017 to December 2017, patients were assessed for risk of developing C. diff. Patients with a score of 13 or over were considered high risk. During this time period, 82 patients had a score over 13 and thus high risk. Of these, 72 (87.8 %) developed C. diff.(1)

During the time period January 2018 to December 2018, 62 patients had a score over 13, and thus high risk. These patients were administered 125mg of oral vancomycin twice daily, with 5 (8%) developing C. diff.(1)

The study concluded: “In institutions where appropriate infection control measures and antibiotic stewardship have been implemented, the use of a prediction tool to guide oral vancomycin prophylaxis is effective in preventing C. difficile.”(1)

 


(1) Van Hise, N. PharmD, Hines, D. MD, Didwania, V. MD, et. al., Open Forum Infectious Diseases, Oral Vancomycin Prophylaxis Works, academic.oup.com

 

Oral Vancomycin and Treatment of CDI in Children

Clostridiodes difficile infection (CDI) is one of the most common healthcare-associated infections in the U.S., leading to 29,300 deaths each year, according to the Centers for Disease Control.(1)

Risk factors for CDI include stay in a healthcare facility, advanced age (over 65), a weakened immune system, being treated with an antibiotic, particularly fluoroquinolones, cephalosporins, penicillin, and clindamycin. Proton pump inhibitors, used to reduce stomach acid, also increase risk.(2)

“The epidemiology of CDI has changed dramatically in recent years, such that CDI is now a growing problem among children.”(3) This increase in CDI in populations that previously had been considered low-risk is happening at the same time a hypervirulent strain of CDI (NAPI) has emerged.(3)

Studies have shown that CDI is more common in children than previously thought, both in community settings and the hospital. There is growing incidence as well as severity in the pediatric population.(4) It should be noted that since CDI is not a reportable disease, surveillance data are somewhat limited.(3) An analysis of the United States National Hospital Discharge Study showed that CDI in children is associated with increased length of stay (in hospital), colectomy, in-hospital mortality and discharge to a care facility. This study reported the median age for children hospitalized with CDI was 3.(4)

Important risk factors for CDI in children include hospitalization in the previous month and use of antibiotics in the previous two months. Several studies have further shown there is increased incidence of CDI among children with inflammatory bowel disease.(3)

“National guidelines recommend oral vancomycin over oral metronidazole as first-line treatment for nonsevere CDI in adults.” While guidelines for treating children with nonsevere CDI have recommended metronidazole, a 2019 study indicates that oral vancomycin had advantages over metronidazole.(5) The study included patients under the age of 18 with nonsevere CDI. To be included in the study the children must have been hospitalized for at least 48 hours with CDI, be over the age of 2, and have no other plausible explanation for diarrhea.(5)

In the study, 141 participants received oral metronidazole and 51 received oral vancomycin. Of the 141 patients receiving oral metronidazole, 71.7% had clinical improvement by day five, compared with the oral vancomycin group, in which 86% had clinical improvement by day five.(5) The researchers concluded: “Our study suggests that children with nonsevere CDI have earlier resolution of clinical symptoms when prescribed vancomycin compared with metronidazole. Large interventional studies are necessary to evaluate the reproducibility of our findings.”(5)

Prophylaxis of oral vancomycin has been used successfully in adults at high risk of CDI. A study published in the journal of the American Academy of Pediatrics aimed to assess the utility of oral vancomycin prophylaxis in pediatric patients at risk of contracting CDI.(6) The study included patients who had a history of CDI, and who were hospitalized. Of these patients, 30 received oral vancomycin prophylaxis, 44 did not.  The incidence of CDI recurrence within 8 weeks of antibiotic exposure was significantly lower in patients who received the prophylaxis, 4% versus 25%.(6)

The study concluded: “Secondary OVP while receiving systemic antibiotics reduces the risk of recurrent CDI in pediatric patients with a history of CDI.”(6)

 


(1) Centers for Disease Control, Clostridiodes Difficile, https://www.cdc.gov/
(2) Mayo Clinic, C. Difficile Infection, https://www.mayoclinic.org/
(3) Sammons, J. MD, Toltzis, P. MD, Zaoutis, T. MD, Journal of the American Medical Association, Clostridium difficile Infection in Children, https://jamanetwork.com/
(4) Gupta, A. MD, Pardi, D. MD, Baddour, L. MD, Gastroenterology Report, Outcomes in Children with Clostridium difficile Infection: Results from a Nationwide Survey, https://www.ncbi.nlm.nih.gov/
(5) Yin, J. MD, Kociolek, L. MD, Same, R. MD, et. al., Infectious Disease, Oral Vancomycin May Be Association with Earlier Symptom Resolution than Metronidazole for Hospitalized Children with Nonsevere Clostridiodes difficile Infections, https://pubmed.ncbi.nlm.nih.gov/
(6) Bao, H/ MD, Lighter, J. MD, Dubrovskaya, Y. MD, Pediatrics, Oral Vancomycin as Secondary Prophylaxis for Clostridiodes difficile Infection, https://pediatrics.aappublications.org/


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