J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 7, Number 6, June 2015, pages 422-427

Vancomycin Enemas as Adjunctive Therapy for Clostridium difficile Infection

Figure 1. CDI treatment for the control group (top) and VPR group (bottom). To be listed as exposed to antimicrobial, the patient had to receive at least 1 day of that therapy. Number of antibiotics > number of patients due to concomitant therapy.

Figure 3. Plot of odds ratio and 95% confidence interval of variables independently associated with the combined endpoint of colectomy and death.

**Table 1.** Characteristics of Study Patients and Controls
	All	Rectal vancomycin (n = 24)	No rectal vancomycin (n = 48)	P value
LOS: length of stay. *Includes prednisone ≥ 20 mg, antineoplastic, antimetabolite, and any immune modulator therapy.
Age (SD), years	61.3 (15.4)	61.8 (15.9)	61.1 (15.3)	0.86
Gender (% male)	36 (50)	11 (45.8)	25 (52.1)	0.62
Immunosuppression* (%)	12 (16.7)	4 (17.4)	8 (16.7)	0.94
Albumin (SD), g/dL	1.95 (0.63)	2.01 (0.59)	1.91 (0.66)	0.56
APACHE II (SD)	20.0 (5.4)	20.0 (5.4)	20.0 (5.5)	1.00
Overall LOS (median, IQR)	26.5 (16.5 - 46.5)	25.0 (19.5 - 37.5)	28.0 (15.5 - 48.0)	0.62
ICU LOS (median, IQR)	13.0 (2.5 - 25.0)	12.0 (0 - 27.5)	14.0 (3.5 - 23.5)	0.72
Episode severity				0.18
Mild-moderate	4 (5.6)	1 (4.2)	3 (6.3)
Severe	28 (38.9)	6 (25)	22 (45.8)
Severe complicated	40 (55.6)	17 (70.8)	23 (47.9)

Table 1. Characteristics of Study Patients and Controls

All

Rectal vancomycin (n = 24)

No rectal vancomycin (n = 48)

P value

LOS: length of stay. *Includes prednisone ≥ 20 mg, antineoplastic, antimetabolite, and any immune modulator therapy.

Age (SD), years

61.3 (15.4)

61.8 (15.9)

61.1 (15.3)

0.86

Gender (% male)

36 (50)

11 (45.8)

25 (52.1)

0.62

Immunosuppression* (%)

12 (16.7)

4 (17.4)

8 (16.7)

0.94

Albumin (SD), g/dL

1.95 (0.63)

2.01 (0.59)

1.91 (0.66)

0.56

APACHE II (SD)

20.0 (5.4)

20.0 (5.5)

1.00

Overall LOS (median, IQR)

26.5 (16.5 - 46.5)

25.0 (19.5 - 37.5)

28.0 (15.5 - 48.0)

0.62

ICU LOS (median, IQR)

13.0 (2.5 - 25.0)

12.0 (0 - 27.5)

14.0 (3.5 - 23.5)

0.72

Episode severity

0.18

Mild-moderate

4 (5.6)

1 (4.2)

3 (6.3)

Severe

28 (38.9)

6 (25)

22 (45.8)

Severe complicated

40 (55.6)

17 (70.8)

23 (47.9)

**Table 2.** Published Reports of VPR
Author (year)	Case report or series (n)	Dose of VPR	Concomitant therapies	Comments
Pasic et al [20] (1993)	Report	2 g loading with 100 mg q6h and 100 mg PRN watery stool	No	Colitis resolution; death from sepsis on POD 52
Shetler et al [21] (2001)	Series (7)	250 mL of premixed solution (1 g vancomycin in 1 L sterile H₂O) q6h	Yes (all IV metronidazole, 5/7 oral vancomycin)	Colitis resolution in four of the seven patients
Nathanson et al [22] (2001)	Report	500 mg in 500 mL saline BID	Yes (IV metronidazole for 10/10 days)	Colitis resolution with discharge to home
Apisarnthanarak et al [23] (2002)	Series (9)	Variable (0.5 - 1 g q4 - q12h)	Yes (all IV/oral metronidazole, 7/9 oral vancomycin)	Resolution in 89%
Kim et al [24] (2013)	Series (47)	1 g q6h	Yes (oral vancomycin and IV)	Resolution without surgery in 70%

Table 2. Published Reports of VPR

Author (year)

Case report or series (n)

Dose of VPR

Concomitant therapies

Comments

Pasic et al [20] (1993)

Report

2 g loading with 100 mg q6h and 100 mg PRN watery stool

Colitis resolution; death from sepsis on POD 52

Shetler et al [21] (2001)

Series (7)

250 mL of premixed solution (1 g vancomycin in 1 L sterile H₂O) q6h

Yes (all IV metronidazole, 5/7 oral vancomycin)

Colitis resolution in four of the seven patients

Nathanson et al [22] (2001)

Report

500 mg in 500 mL saline BID

Yes (IV metronidazole for 10/10 days)

Colitis resolution with discharge to home

Apisarnthanarak et al [23] (2002)

Series (9)

Variable (0.5 - 1 g q4 - q12h)

Yes (all IV/oral metronidazole, 7/9 oral vancomycin)

Resolution in 89%

Kim et al [24] (2013)

Series (47)

1 g q6h

Yes (oral vancomycin and IV)

Resolution without surgery in 70%