title: Comparison of oral vancomycin capsule and solution for treatment of initial episode of severe Clostridium difficile Infection.
abstract: OBJECTIVE
  Vancomycin is recommended as a first-line therapy for severe Clostridium difficile infection (CDI). Due to the high cost of commercially available vancomycin capsules, hospitals frequently compound oral solution despite a lack of data comparing outcomes. This study was conducted to determine treatment outcome differences based on oral vancomycin formulation.
  
  
  METHODS
  Medical charts of 76 patients with an initial episode of severe CDI receiving oral vancomycin as a commercially available capsule or a compounded oral solution for at least 72 hours were retrospectively reviewed. The primary objective was to compare the time to clinical cure of CDI.
  
  
  RESULTS
  Baseline characteristics between groups were similar except for the median lactate, which was higher in compounded oral solution group (1.5 vs 0.6 mmol/L, P < .001). There was no difference in clinical cure at day 10 (64% solution vs 59% capsules, P = .664). Median time to clinical cure was 8 days for solution and 7 for capsules (P = .597). After adjustment, the hazard ratio of time to clinical cure for solution compared to capsules was 1.15 (P = .69). No significant differences in mortality, recurrence, or complications were noted.
  
  
  CONCLUSIONS
  Formulation of oral vancomycin did not impact treatment outcomes in this retrospective study.
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA basss@ccf.org.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Bass
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Lam
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Seth R
authors.initials: SR
authors.lastname: Bauer
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Neuner
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002214:Capsules; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000188:drug therapy*; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012996:Solutions; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D002214:Capsules; D012996:Solutions; D014640:Vancomycin
keywords: Clostridium difficile; capsule; oral solution; vancomycin